Dept. of Clinical Pharmacy, Obafemui Awolowo University, ILE-IFE

Abstract:

Background: Antibiotics are commonly used in the management of diabetic patients and there is a need to evaluate their use to improve therapeutic outcomes and avoid practices that may increase antimicrobial resistance.  The aim of this study was to evaluate antibiotic utilization in the diabetic clinic of a Nigerian tertiary hospital.

Methods: A retrospective evaluation and analysis of patients’ case notes written by physicians attending the diabetics clinic over a three-year period (January, 2008 – December, 2010) was conducted. Prescribing indicators from the WHO selected drug use indicators guideline of 1993 were used to study the pattern of antibiotic use for the years under study. Prescribing indicators used where

a) Average number of antibiotics per encounter was calculated by dividing the total number of antibiotics prescribed by the number of encounters surveyed.

b) Percentage of antibiotics prescribed by generic name was determined by dividing the number of antibiotics prescribed by generic name by the total number of antibiotics prescribed, multiplied by 100.

c) Percentage of antibiotics prescribed as injections was calculated by dividing the number of antibiotics prescribed in injection form by the total number of antibiotics prescribed, multiplied by 100.

d) Percentage of antibiotics prescribed from essential drug list was determined by dividing the number of antibiotics prescribed from essential drug list of the hospital by the total number of antibiotics prescribed, multiplied by 100.

Results: A total of 150 case notes were collected for the three year period. The total number of antibiotics prescribed ranged from none to three per case. All the antibiotics prescribed were in the essential drug list in use at the hospital and the classes include cephalosporins, penicillins, quinolones, macrolides, aminoglycosides, antibacterials and antifungals. Mean number of antibiotic per prescription increased from 1.32 in 2008, 1.37 in 2009 and 1.67 in 2010 when the means were compared, there was no statistically significant difference as standard deviation for 2008/2009 equals 0.86 and 2009/2010 equalled 0.78. Antibiotics were included in 133 (88.7%) of the 150 prescriptions evaluated.  Generic prescription increased from 36 in 2008/2009 to 52.3 in 2009/2010 the difference being statistically significant with a standard deviation value of 8.44. Parenteral administration accounted for 45.3% while 65.1% of the antibiotics used were generics. When generics drugs where compared to parenteral at P-Values of 0.05, the value obtained was 0.112 which shows a significant difference. Parenteral administration increased from 50 in 2008/2009 to 75 in 2009/2010, the difference being statistically significant with a standard deviation value of 14.124. Five antibiotics were frequently prescribed either singly or in combinations. The first was metronidazole (34.7%), followed by ciprofloxacin (32.7%), amoxicillin (20.0%), erythromycin (15.3%), and ceftriazone (14.7%). Ninety two percent (92.0%) of the prescriptions complied with the recommended dosage regimen of the antibiotics in terms of dose, frequency, duration and indications for use. The antibiotics where used to manage diabetic complications like diabetic foot gangrene, injection abscess, septiceamia, diabetic foot ulcer, vaginal yeast infection, amongst others.

Conclusions: The results of the study indicate that there was a high degree of compliance with antibiotic use guideline at the diabetic clinic, but there is a need to update and develop a new antibiotic use protocol in the hospital in order to include newer drugs available in the market.

Keywords: Antibiotics, diabetes, infection and WHO.