Drug use Evaluation of Ciprofloxacin in the Outpatient Department of Dessie Referral Hospital (DRH), North East Ethiopia

Research Article

Austin Emerg Med. 2015; 1(1): 1001.

Drug use Evaluation of Ciprofloxacin in the Outpatient Department of Dessie Referral Hospital (DRH), North East Ethiopia

Oumer S Muhammed*

Department of Pharmacy, Wollo University, College of Medicine and Health Sciences, Ethiopia

*Corresponding author: Oumer S Muhammed, Department of Pharmacy, Wollo University, College of Medicine and Health Sciences, Ethiopia

Received: October 14, 2015; Accepted: October 20, 2015; Published:November 16, 2015

Abstract

Background: Many infectious diseases once considered incurable and lethal are now amenable to treatment with antimicrobial agents. They are among the most frequently prescribed medications today although microbial resistance due to evolutionary and misuse threatens their continued efficacy. On the other hand, ciprofloxacin and other antibiotics are often used inappropriately leading to wastage of scarce healthcare resources as well as increasing the risk of the emergence of bacterial resistance Inappropriate treatment could also lead to the ultimate death of the patient.

Objectives: To evaluate ciprofloxacin use in the outpatient department of Dessie Referral Hospital (DRH).

Methodology: A retrospective DUE (Drug Use Evaluation) was conducted by reviewing medication records of 372 patients who received ciprofloxacin in DRH during the period of March 16, 2013 to March 15, 2014. A systematic sampling method was used to select patient cards.

Results: 287 (77.2%) patients were in the age group of 18 to 49 years. Indication three hundred sixteen (85%), dose 275 (87%) and frequency two hundred ninety seven (93.99%) were consistent with the WHO indicators. Two hundred four (64.56%) of the cases had correct duration of treatment. Percentage of the cases with potential drug interactions was one hundred ninety four (52.15%). Fifteen of ciprofloxacin use was against contraindication.

Conclusion: From the current study, it was identified that there was irrational ciprofloxacin use in the outpatient department of DRH even though the drug’s use regarding frequency was a better performance and dosing practices were almost appropriate as per the criteria used for the study. There was a great problem concerning the indication and duration of ciprofloxacin drug therapy. Ciprofloxacin use along with potentially interacting drugs and against contraindications was also another problem indicated in the study.

Keywords: Drug use evaluation; Drug resistance; DRH; Ciprofloxacin; Antibiotics

Abbreviations

WHO: World Health Organization; AFI: Acute Febrile Illness; DRH: Dessie Referral Hospital; DUE: Drug Use Evaluation

Background

Rational use of drugs provide patients with appropriate medication to their clinical needs, at dose that meet their own individual requirements for an adequate period of time at lowest cost [1].

Drug use is complex subject involving the physician, the patient, the pharmaceutical institution and dispenser. Each of these is influenced by many factors that are often difficult to measure and quantify. Despite complexity of the drug use, a number of indicators have been developed, standardized and evaluated by WHO/world health organization, which provides useful means of measuring certain aspects of country’s drug use.

Antibiotics are among the most frequently prescribed medications today although microbial resistance due to evolutionary pressures and misuse threatens their continued efficacy. Unfortunately we cannot any longer confidently depend upon the discovery of an increasing numbers of novel antibiotics and antimicrobial agents to keep infectious diseases under control but must increasingly pay attentions to neglected public health measures and concentrate upon using antibiotics safely and effectively [1-3].

The discovery and use of antimicrobial agents have brought a major breakthrough in therapy. A lot of previously intractable infectious conditions have now become amenable to antimicrobial therapy. Various classes of antibiotics have been discovered and used with varying degrees of success. Among these are the quinolones. Older members of this group, like the nalidixic acid, have been available for the treatment of urinary tract infections. However the limited use of this drug coupled with the rapid development of resistant strains became a problem [4].

Ciprofloxacin is used for various diseases in Ethiopia, like Bacillary Dysentery, Gastro-enteritis, Pneumonia, Typhoid fever, Chancroid and Gonorrhea. On the other hand, ciprofloxacin and other antibiotics are often used inappropriately leading to wastage of scarce healthcare resources as well as increasing the risk of the emergence of bacterial resistance [5].

Evaluation of ciprofloxacin use is therefore critical for controlling the emergence of resistant strains as well as cutting down of unnecessary expenditures and also ensuring that patients derive maximum benefit from its use. Therefore, the objective of this study was to evaluate ciprofloxacin use in outpatient department of Dessie Referral Hospital.

Methodology

Study area and period

The study was conducted in Dessie referral Hospital which is one of the biggest referral hospitals in the region. The Hospital has 200 beds with 165 health professionals and has different specialized service in five major departments; the pediatrics; surgery; gynecology, Outpatient Department(OPD) and internal medicine. It is located 401kms far from Addis Ababa. The data was collected from April 7, 2014 to April 20, 2014.

Study design

A retrospective, cross sectional study was conducted to evaluate ciprofloxacin use based on the WHO Criteria along with thresholds set by experts for undertaking drug use evaluation for ciprofloxacin was used. Medical cards of the OPD existing from March 16, 2013 to March 15, 2014 were evaluated and those fulfilling the inclusion criteria were included.

Eligibility criteria

Cards which contain ciprofloxacin with indication, dose, frequency and duration were included. And cards with incomplete information were exempted from the study.

Sample size

The size of the sample population was determined according to the Joint Commission on the Accreditation of Health Care Organization (JCAHO) criteria. From the study which encompasses 1 year data of ciprofloxacin use in the outpatient department of Dessie referral hospital, the number of cases (ciprofloxacin indications) per quarter was found to be 867(a total of 3465 annual cases). Therefore 372(10%) was the size of sample in the study [6].

Data collection

The data was abstracted from the patient charts by two trained year 5 pharmacy students using the data collection format which was adapted from other studies. The data collection format was pre-tested for its validity, reliability and consistency. And the collected formats were cleaned and coded.

Data processing and analysis

The data was processed using Microsoft excel and analyzed by using WHO for drug use evaluation.

Ethical consideration

A formal letter was written to Dessie referral hospital administrative. Confidentiality of the information obtained from the patient’s medical record was maintained throughout the study period by coding and putting in the locked cabinet.

Results

A total of 372 patient charts containing ciprofloxacin order were included in the study. Two hundred nine (56%) of them were females. Surprisingly, pregnancy and lactating status in females was not indicated in any of the cases. The age range was between fifteen and eighty five years (Table 1).