Rajiv Gandhi University of Health Sciences



SYNOPSIS

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

“EVALUATION OF ANTIBIOTIC PRESCRIPTION PATTERN IN IN-PATIENTS WITH URINARY TRACT INFECTION IN A TERTIARY CARE CENTRE”

Name of the candidate : Dr. TANYA MARY THOMAS

Guide : Dr. PADMAJA UDAYKUMAR

Course and Subject : M.D. PHARMACOLOGY

Department Of Pharmacology,

Father Muller Medical College,

Kankanady, Mangalore – 575 002.

2012

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1 |Name of the |DR. TANYA MARY THOMAS |

| |Candidate |POST GRADUATE RESIDENT, |

| |and Address |DEPARTMENT OF PHARMACOLOGY, |

| |(In Block Letters) |FATHER MULLER MEDICAL COLLEGE, KANKANADY, |

| | |MANGALORE-575002 |

|2 |Name of the |FATHER MULLER MEDICAL COLLEGE HOSPITAL, KANKANADY, MANGALORE – 575002 |

| |Institution | |

|3 |Course of the Study and Subject |M.D. PHARMACOLOGY |

|4 |Date of Admission to Course |09.04.2012 |

|5. |Title of the Topic: |

| |“EVALUATION OF ANTIBIOTIC PRESCRIPTION PATTERN IN |

| |IN-PATIENTS WITH URINARY TRACT INFECTION IN |

| |A TERTIARY CARE CENTRE” |

|6 |BRIEF RESUME OF THE INTENDED WORK: |

| | |

| |6.1 NEED FOR THE STUDY |

| | |

| |Urinary Tract Infection (UTI) is a common infection seen in both outpatient and inpatient settings. Every year 150 million people are |

| |diagnosed with UTI, world wide .(1) |

| |Uncomplicated UTI is more frequently seen in young healthy non-pregnant women with no functional or anatomic abnormalities of the |

| |urinary tract. E.coli accounts for 80% of uncomplicated UTI followed by Staphylococcus saprophyticus (10% - 15%).(2) Factors like |

| |age, diabetes, spinal cord injury, or catheterization further complicate UTI. Microorganisms |

| |responsible for complicated UTI belong to a broader range when compared to uncomplicated |

| |UTI. They include E.coli, Klebsiella spp.,Group B Streptococci, Enterobacter cloacae, Enterococcus faecalis, Serratia marcescens, |

| |Pseudomonas and Proteus mirabilis.(3) |

| |Initial choice of antibiotic therapy in UTI depends on the knowledge of the predominant uropathogen, antibiotic sensitivity pattern in |

| |the locality and cost factors. However empirical antibiotic therapy is often associated with high levels of unnecessary antibiotic |

| |usage.(4) Appropriate antibiotic therapy therefore reduces the risk of antibiotic resistance and hence prevents treatment failure. |

| |The aim of this study is to evaluate the pattern of usage of antibiotics in in-patients admitted with UTI and to evaluate the |

| |uropathogens and their antibiotic sensitivity pattern. |

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| |6.2 REVIEW OF LITERATURE |

| |McIsaac et al. conducted a study in Canada to evaluate the prescribing patterns and antibiotic preferences of physicians for the |

| |management of acute uncomplicated cystitis in women. In this study 86.9% of women were prescribed antibiotics. 32.8% of patients who |

| |received antibiotic prescription were found to be negative for urine culture. Trimethoprim/ sulfamethoxazole (40.8%) was the most |

| |commonly prescribed antibiotic followed by fluoroquinolones (27.4%) and nitrofurantoin (26.6%).(4) |

| |Study conducted by Akram et al. showed that E.coli (61%) was the most common uropathogen in culture positive patients followed by |

| |Klebsiella spp (22%). The majority (66.66%) of the isolates were from female patients. 51.04% of UTI cases belonged to young and |

| |middle age group (20-49 yrs). Gram-negative enteric bacilli showed high prevalence of resistance against ampicillin and |

| |co-trimoxazole.(5) |

| |Martínez et al. conducted a cross-sectional study on 3797 patients with acute urinary tract infection aged 14 years and above. |

| |Ciprofloxacin and amoxicillin- clavulanate were the commonly prescribed antibiotics. Whereas in pregnant women with lower UTI |

| |fosfomycin was the most frequently prescribed antibiotic. Trimethoprim- sulfamethoxazole was the least prescribed antibiotic (2%). Lower|

| |UTI constituted 81 % of cases. Their study observed that the appropriateness of antibiotic prescriptions showed significant variability|

| |among the participating centres.(6) |

| |A Hospital based cross-sectional study conducted by Beyene et al. showed that Escherichia coli (33.3%) was the predominant pathogen |

| |isolated. All isolates of E. coli and K. pneumoniae were found to be susceptible to ciprofloxacin. This study also revealed that |

| |there was least resistance against drugs such as ceftriaxone, gentamicin and chloramphenicol for all UTI isolates.(7) |

| | |

| |6.3 OBJECTIVES OF THE STUDY |

| |To study the pattern of antimicrobial therapy in in-patients with urinary tract infection in a tertiary care health centre. |

| |To study the pattern of antibiotic sensitivity in culture positive in-patients with urinary tract infection. |

| | |

| |7. MATERIAL AND METHODS: |

| |7.1 SOURCE OF DATA |

| |Medical Records Department, Father Muller Medical College, Mangalore. The study period is from December 2012 - November 2013. |

| |TYPE OF STUDY: |

| |Retrospective, Descriptive hospital based study. |

| |7.2 METHOD OF COLLECTION OF DATA |

| |The data will be collected from patient’s medical records from August 2011 to July 2012 (1year). |

| |Sample size: All in-patients above 18years of age admitted to FMMC, Mangalore with a diagnosis of urinary tract infection, from |

| |August 2011 to July 2012 will be included in the study. |

| |Methods: The following data of each patient will be recorded in the proforma. Detailed history, physical examination, associated risk|

| |factors, investigations performed, microbiological reports, antibiotic treatment given and other treatment given. |

| | |

| |SELECTION CRITERIA: |

| |a. Inclusion Criteria: |

| |All in-patients above 18 years of age admitted to FMMC, Mangalore with a diagnosis |

| | |

| |of urinary tract infection from August 2011 to July 2012. |

| | |

| |b. Exclusion Criteria: |

| |1. Patients of age less than 18 years. |

| |2. Inadequate case records or data. |

| |3. Severely ill patients. |

| |DATA ANALYSIS: |

| |The collected data will be analyzed using mean, frequency, percentage, standard deviation and chi- square test. |

| |7.3 Does the study require any investigations or interventions to be conducted on or other humans? |

| |No |

| |7.4 Has ethical clearance been obtained from your institution? |

| |Yes |

| | |

|8. |LIST OF REFERENCES |

| |Gonzalez CM, Schaeffer AJ. Treatment of urinary tract infection: what's old, what's new, and what works. World J Urol. 1999 Dec;17(6):372-82.|

| |Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med. 1993 Oct 28;329(18):1328-34. |

| |Ronald A. The etiology of urinary tract infection: traditional and emerging pathogens. Dis Mon. 2003 Feb;49(2):71-82. |

| |McIsaac WJ, Prakash P, Ross S. The management of acute uncomplicated cystitis in adult women by family physicians in Canada. Can J Infect Dis|

| |Med Microbiol. 2008 Jul; 19(4):287-93. |

| |Akram M, Shahid M, Khan AU. Etiology and antibiotic resistance patterns of community - acquired urinary tract infections in J N M |

| |C Hospital Aligarh, India. Ann Clin Microbiol Antimicrob. 2007 Mar 23;6:4. doi:10.1186/1476-0711-6-4. |

| |Martínez MA, Inglada L, Ochoa C, Villagrasa JR; Spanish Study Group On Antibiotic Treatments. Assessment of antibiotic prescription in acute |

| |urinary tract infections in adults. J Infect. 2007 Mar;54(3):235-44. |

| |Beyene G, Tsegaye W. Bacterial uropathogens in urinary tract infection and antibiotic susceptibility pattern in jimma university |

| |specialized hospital, southwest ethiopia. Ethiop J Health Sci. 2011 Jul;21(2):141-6. |

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|9. |Signature of Candidate | |

|10 |Remarks of the Guide | |

|11 |Name and designation (in block letters) |Dr. PADMAJA UDAYKUMAR |

| | |M.B.B.S, M.D |

| |11.1 Guide |PROFESSOR AND HOD, |

| | |DEPARTMENT OF PHARMACOLOGY, |

| | |FATHER MULLER MEDICAL COLLEGE, MANGALORE – 575 002 |

| |11.2 Signature | |

| |11.3 Co Guide | |

| | | |

| |11.4 Signature | |

| |11.5 Head of the department |Dr. PADMAJA UDAYKUMAR |

| | |M.B.B.S, M.D |

| | |PROFESSOR AND HOD, |

| | |DEPARTMENT OF PHARMACOLOGY, |

| | |FATHER MULLER MEDICAL COLLEGE, MANGALORE – 575 002 |

| |11.6 Signature | |

|12 |12.1 Remarks of the Chairman & | |

| |Principal | |

| |12.2 Signature | |

PROFORMA

NAME : AGE: SEX

IP / OP NUMBER: DATE OF ADMISSION:

DATE OF DISCHARGE:

DEPARTMENT:

CLINICAL PRESENTATION:

PAST HISTORY: DM [Y/N], HYPERTENSION [Y/N]

PERSONAL HISTORY:

FAMILY HISTORY:

OCCUPATIONAL HISTORY:

TREATMENT HISTORY:

GENERAL EXAMINATION

Pallor Icterus Clubbing Cyanosis

Lymphadenopathy Edema

PULSE: BP: TEMPERATURE:

SYSTEMIC EXAMINATION:

P/A

CVS

RS

CNS

Associated illness

INVESTIGATIONS CARRIED OUT:

1. BLOOD ROUTINE:

2. URINE ROUTINE:

3. RFT:

4. LFT:

5. USG FINDINGS:

URINE CULTURE AND SENSITIVITY REPORT:

ANTI BIOTIC TREATMENT GIVEN:

|BRAND NAME: |GENERIC NAME |DOSE |DOSAGE |ROUTE |DURATION |

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OTHER TREATMENT GIVEN:-

|BRAND NAME |GENERIC NAME |DOSE |DOSAGE | ROUTE |

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