1. SURVEILLANCE OF ANTIMICROBIAL USE AT ALL LEVELS OF THE HEALTH SECTOR: AN INTERVENTION IN ITSELF? Thatte UM, Kulkarni RA, Holloway K, Sorenson T, Koppikar GV, Shinkre N, Chaudhury RR TNMC & BYL Nair Charitable Hospital, Mumbai 400 008

2. Background  Antimicrobial resistance: a global problem  Irrational prescribing of antibiotics and lack of adequate patient knowledge contributes to this problem

3. Objective To determine and compare, in a specified area of Mumbai, the antimicrobial usage patterns at different levels of the health care system. Study Design : Prospective, time series study over one year

4. E-ward 4.5 lakh population 1 tertiary care hospital 12 municipal dispensaries (MD) 120 Private practitioners (GP) 75 Chemists

5. Study setting Institutional Ethics Committee permission  Medicine and Pediatric Out Patient Departments (OPD) of tertiary hospital  9 Municipal dispensaries (MD)  90 Private Practitioners (GPs)  65 Chemist shops (Ch) Data collection: Exit interviews Prescription audit 300 patients & prescriptions per month

6. Outcome measures  Average number of drugs prescribed per patient  % patients prescribed antimicrobials  % patients prescribed multiple antimicrobials  % patients prescribed antimicrobials in underdosage  % patients treated in accordance with clinical guidelines  % patients who know their dosing regimens

7. Percentage antibiotics of total drugs prescribed 25-30% were antibiotics 3-4 drugs prescribed per patient, of which 25-30% were antibiotics Commonly prescribed antibiotics OPD & MD: Cotrimoxazole & Amoxycillin GP & Chemists: Quinolones & Cephalexin 5-25% patients prescribed multiple antibiotics including combinations; more commonly at GPs & chemists

8. % Antibiotics dispensed from the facility Dispensing GPs!!! % antibiotics prescribed as Generics OPD & MD: 30 – 40% GPs : 40-60%

9. % patients prescribed antibiotics in under-dosage Less than 10% patients prescribed antibiotics correctly as per clinical guidelines, except at OPDs

10. Chemist shops Less than 5% patients given correct and complete information regarding antibiotics dispensed by chemist Less than 2% patients dispensed antibiotics without prescriptions at Chemist shops: Intervention due to the presence of field officers??

11. % patients with adequate knowledge of the dosing schedule of the prescribed drugs Good knowledge w.r.t dosing schedule: Intervention due to the presence of field officers??

12. % patients with knowledge that antibiotic has been prescribed Inadequate knowledge!!! % patients with knowledge that incomplete Rx can cause resistance

13. Conclusion  Antibiotic prescribing rampant at all levels of health care, especially in the private sector  Patient knowledge woefully inadequate: Less than 10% patients prescribed antibiotics as per clinical guidelines Less than 5% aware that an antibiotic has been prescribed and that incomplete therapy can cause drug resistance  Inadvertent interventions: Decrease in number of antibiotics dispensed without prescriptions at chemists Improved patient information w.r.t dosage schedule