European Journal of Cardiovascular Medicine

Antibiotics are among the most frequently prescribed medications in clinical practice and play a pivotal role in reducing the morbidity and mortality associated with infectious diseases. However, the inappropriate and excessive use of antibiotics has become a growing public health concern, contributing significantly to the emergence and spread of antimicrobial resistance (AMR) globally (1,2). The World Health Organization (WHO) has identified AMR as one of the top ten global public health threats, emphasizing the urgent need to monitor and rationalize antibiotic use in healthcare settings (3).

Antibiotic prescription practices vary widely among healthcare institutions, influenced by factors such as physician knowledge, diagnostic uncertainty, patient expectations, and availability of local treatment guidelines (4,5). In tertiary care hospitals, the use of broad-spectrum antibiotics and empirical therapy without adequate microbiological confirmation is particularly prevalent, which may lead to poor patient outcomes, increased healthcare costs, and heightened AMR risk (6,7).

Evaluating antibiotic prescription patterns through prospective audits is essential for understanding current practices and identifying areas for intervention. Such studies provide a baseline for implementing antibiotic stewardship programs and promoting rational drug use (8). While several studies from India and other low- and middle-income countries have reported patterns of antibiotic use, there remains a gap in ongoing surveillance and institutional policy implementation in many tertiary care settings (9,10).

This study was undertaken to assess the pattern of antibiotic prescriptions in a tertiary care hospital, with the aim of evaluating the frequency, indications, routes, and guideline adherence of antibiotic usage. The findings are expected to contribute to evidence-based policy-making and reinforce antimicrobial stewardship initiatives

This prospective observational study was conducted in a tertiary care teaching hospital over a period of three months. The study aimed to assess the pattern of antibiotic prescriptions among both inpatient and outpatient departments.

Study Design and Setting:
The study was designed as a prospective, hospital-based observational analysis carried out in the Departments of General Medicine, Surgery, Pediatrics, and Emergency Medicine. The hospital serves as a referral center catering to a diverse patient population.

Inclusion and Exclusion Criteria:
Prescriptions containing at least one antibiotic issued to patients of all age groups and genders were included. Prescriptions with incomplete data or those from departments not routinely involved in antibiotic prescribing (e.g., dermatology, ophthalmology) were excluded.

Sample Size and Sampling Technique:
A total of 420 prescriptions were randomly selected using a stratified sampling method to ensure proportional representation from each clinical department.

Data Collection:
Data were collected using a pre-validated structured data collection form. Information recorded included patient demographics (age, sex), clinical diagnosis, name and number of antibiotics prescribed, route and frequency of administration, duration of therapy, and whether culture and sensitivity testing was performed. Prescriptions were also assessed for adherence to standard treatment guidelines such as those from the World Health Organization (WHO) and the Indian Council of Medical Research (ICMR).

Data Analysis:
Descriptive statistics were used to analyze the data. Frequencies and percentages were calculated for categorical variables such as antibiotic class, route of administration, and empirical versus targeted therapy. The analysis was performed using Microsoft Excel and SPSS version 26.0.

A total of 420 prescriptions were analyzed during the study period, of which 290 (69.0%) contained at least one antibiotic. The demographic distribution of patients who received antibiotics is presented in Table 1. The majority of prescriptions were issued for male patients (56.6%), and the highest frequency of antibiotic use was observed in the age group of 21–40 years (38.3%).

The most commonly prescribed class of antibiotics was cephalosporins (38.6%), followed by fluoroquinolones (22.4%) and penicillin combinations (16.2%) as shown in Table 2. Less frequently used classes included macrolides (8.3%), carbapenems (5.2%), and aminoglycosides (4.5%).

Route of administration was predominantly intravenous (57.9%), followed by oral (39.7%) and intramuscular (2.4%) (Table 3). In terms of prescription intent, 214 (73.8%) of antibiotics were prescribed empirically, with culture and sensitivity testing documented in only 76 cases (26.2%).

Table 1: Demographic Characteristics of Patients Receiving Antibiotic Prescriptions (n = 290)

Table 2: Distribution of Antibiotics by Class (n = 342 antibiotics)

Table 3: Route of Antibiotic Administration (n = 342 antibiotics)

As shown in Table 2, cephalosporins were the dominant class prescribed, reflecting a high reliance on broad-spectrum agents. The use of empirical therapy without sensitivity testing (Table 3) indicates a substantial gap in microbiological-guided treatment approaches.

The present study evaluated the antibiotic prescription patterns in a tertiary care hospital and found that 69% of prescriptions included at least one antibiotic, highlighting the high prevalence of antibiotic use in clinical practice. This finding is consistent with previous studies conducted in similar healthcare settings, where antibiotic prescription rates ranged from 60% to 75% (1,2).

Cephalosporins emerged as the most frequently prescribed class of antibiotics (38.6%), followed by fluoroquinolones (22.4%) and beta-lactam/beta-lactamase inhibitor combinations (16.2%). This pattern mirrors the findings of multiple Indian and international studies, suggesting a widespread preference for broad-spectrum agents (3–5). Such practices may stem from diagnostic uncertainty, clinical urgency, or habitual prescribing trends (6).

A notable concern identified in this study was the high rate of empirical antibiotic use (73.8%), with culture and sensitivity testing performed in only 26.2% of cases. This aligns with findings from other prospective studies where microbiological confirmation was underutilized, thereby limiting opportunities for targeted therapy (7,8). The consequences of empirical overuse include suboptimal treatment outcomes, increased resistance rates, and unnecessary healthcare costs (9).

The preference for parenteral administration (57.9%) over oral routes (39.7%) in this study raises additional concerns. Although intravenous therapy may be justified in severe infections or hospitalized patients, its overuse contributes to patient discomfort, longer hospital stays, and increased workload on healthcare staff (10,11). Rational antibiotic prescribing involves appropriate route selection based on infection severity, pharmacokinetics, and patient status (12).

Only 52% of the prescriptions in our study complied with established guidelines from bodies such as the WHO or ICMR. This suggests a significant gap between recommended and actual clinical practice. Similar findings have been reported in studies from Pakistan, Nepal, and India, indicating the urgent need for uniform implementation of antimicrobial stewardship programs (13–15).

The overuse of cephalosporins and fluoroquinolones, in particular, has been linked to the development of extended-spectrum beta-lactamase (ESBL)-producing organisms and fluoroquinolone-resistant strains, both of which are rising concerns in tertiary care settings (6,7). Antimicrobial resistance is no longer a localized issue but a global health crisis that threatens the efficacy of current treatment modalities (8).

To address this issue, the establishment of antimicrobial stewardship interventions—such as formulary restrictions, antibiotic de-escalation, and audit-feedback mechanisms—has shown positive outcomes in optimizing prescription practices (19,20). Moreover, educating prescribers about rational antibiotic use and integrating decision-support systems into hospital information technology can further enhance compliance (1,2).

This study has certain limitations. Being conducted at a single center, the findings may not be generalizable to all healthcare settings. Additionally, the study did not assess patient outcomes or microbiological data in detail. Despite these limitations, the results provide valuable insights and a foundation for policy-making aimed at curbing irrational antibiotic use.

In conclusion, this study highlights the need for systematic efforts to improve antibiotic prescribing practices in tertiary care hospitals. Incorporating regular audits, clinical guideline dissemination, and robust stewardship programs will be critical to preserving antibiotic efficacy and combating antimicrobial resistance

1. Wattal C, Khanna S, Goel N, Oberoi JK, Rao BK. Antimicrobial prescribing patterns of surgical speciality in a tertiary care hospital in India: Role of persuasive intervention for changing antibiotic prescription behaviour. Indian J Med Microbiol. 2017;35(3):369-75.
2. Wattal C, Goel N, Khanna S, Byotra SP, Laxminarayan R, Easton A. Impact of informational feedback to clinicians on antibiotic-prescribing rates in a tertiary care hospital in Delhi. Indian J Med Microbiol. 2015;33(2):255-9.
3. Rupali P, Palanikumar P, Shanthamurthy D, Peter JV, Kandasamy S, Zacchaeus NGP, et al. Impact of an antimicrobial stewardship intervention in India: Evaluation of post-prescription review and feedback as a method of promoting optimal antimicrobial use in the intensive care units of a tertiary-care hospital. Infect Control Hosp Epidemiol. 2019;40(5):512-9.
4. Cisneros JM, Neth O, Gil-Navarro MV, Lepe JA, Jiménez-Parrilla F, Cordero E, et al. Global impact of an educational antimicrobial stewardship programme on prescribing practice in a tertiary hospital centre. Clin Microbiol Infect. 2014;20(1):82-8.
5. Newman KL, Varkey J, Rykowski J, Mohan AV. Yelp for Prescribers: A Quasi-Experimental Study of Providing Antibiotic Cost Data and Prescription of High-Cost Antibiotics in an Academic and Tertiary Care Hospital. J Gen Intern Med. 2015;30(8):1140-6.
6. Bashir A, Gray J, Bashir S, Ahmed R, Theodosiou E. Critical points in the pathway of antibiotic prescribing in a children's hospital: the Antibiotic Mapping of Prescribing (ABMAP) study. J Hosp Infect. 2019;101(4):461-6.
7. Gjelstad S, Fetveit A, Straand J, Dalen I, Rognstad S, Lindbaek M. Can antibiotic prescriptions in respiratory tract infections be improved? A cluster-randomized educational intervention in general practice—the Prescription Peer Academic Detailing (Rx-PAD) Study. BMC Health Serv Res. 2006;6:75.
8. Ahmed SA, Kumar A, Sethi P, Kapil A, Pandey RM, Wig N. Effectiveness of education and antibiotic control programme at All India Institute of Medical Sciences, New Delhi. Natl Med J India. 2018;31(5):262-7.
9. Molina J, Peñalva G, Gil-Navarro MV, Praena J, Lepe JA, Pérez-Moreno MA, et al. Long-term impact of an educational antimicrobial stewardship program on hospital-acquired candidemia and multidrug-resistant bloodstream infections: A quasi-experimental study of interrupted time-series analysis. Clin Infect Dis. 2017;65(12):1992-9.
10. Avent ML, Hansen MP, Gilks C, Del Mar C, Halton K, Sidjabat H, et al. General Practitioner Antimicrobial Stewardship Programme Study (GAPS): protocol for a cluster randomised controlled trial. BMC Fam Pract. 2016;17:48.
11. Fürst J, Čižman M, Mrak J, Kos D, Campbell S, Coenen S, et al. The influence of a sustained multifaceted approach to improve antibiotic prescribing in Slovenia during the past decade: findings and implications. Expert Rev Anti Infect Ther. 2015;13(2):279-89.
12. Lee KR, Bagga B, Arnold SR. Reduction of broad-spectrum antimicrobial use in a tertiary children's hospital post antimicrobial stewardship program guideline implementation. Pediatr Crit Care Med. 2016;17(3):187-93.
13. Hemkens LG, Saccilotto R, Reyes SL, Glinz D, Zumbrunn T, Grolimund O, et al. Personalized prescription feedback to reduce antibiotic overuse in primary care: rationale and design of a nationwide pragmatic randomized trial. BMC Infect Dis. 2016;16:421.
14. Nzegwu NI, Rychalsky MR, Nallu LA, Song X, Deng Y, Natusch AM, et al. Implementation of an antimicrobial stewardship program in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2017;38(10):1137-43.
15. Zhang ZG, Chen F, Ou Y. Impact of an antimicrobial stewardship programme on antibiotic usage and resistance in a tertiary hospital in China. J Clin Pharm Ther. 2017;42(5):579-84.