Prescribing practices of antibiotics and analgesics in orthopedic surgery in two teaching hospitals in pakistan
Zakir Khan1, Naveed Ahmed2, Shaista Zafar3, Asim ur. Rehman2, Faiz Ullah Khan4, Yusuf Karatas5
1 Department of Pharmacology (Pharmacovigilance), Institute of Health Sciences, Çukurova University, Adana, Turkey; Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
2 Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
3 Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
4 Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan; Department of Pharmacy, Administration and Clinical Pharmacy, School of Pharmacy, Health Science Centre, Xi'an Jiaotong University, China
5 Department of Pharmacology, Faculty of Medicine, Çukurova University; Department of Pharmacology, Pharmacovigilance Specialist, Balcali Hospital, Adana, Turkey
Mr. Zakir Khan
Department of Pharmacology (Pharmacovigilance), Institute of Health Sciences, Çukurova University, Adana, Turkey.
Source of Support: None, Conflict of Interest: None
Background: A judicious utilization of antibiotic prophylaxis and postoperative analgesics are an effective strategy to prevent surgical site infections and pain, respectively. Aims: The aim of this study was to assess prescription practices and guidelines adherence of antibiotics and analgesics in total knee replacement (TKR) surgery. Setting and Design: A cohort observational pilot study was conducted for a period of 2 months at two tertiary care teaching hospital (government hospital = GH and private hospital = PH) in Islamabad, Pakistan. Subjects and Methods: All the individuals aged ≥18 who underwent TKR surgery with no previous surgery and infection (n = 300) were included during the study period. The patient medication profile was analyzed through various indicators. International evidence-based guidelines were used as a reference to analyze current treatment practices. Statistical Analysis Used: Descriptive statistics such as frequencies, percentages, averages, standard deviation, and Chi-square test was used for interpretation of data in SPSS V-22.0. Results: Preoperative prophylactic antibiotics were prescribed in 94% (n = 283) cases. Of these, 61.5% adhered according to guidelines with respect to correct choice, 64.6% for timing, and 100% for the route (optimal value 100%). The prescribing behavior with respect to antibiotic choice and timing was different among GH and PH hospitals (P = 0.001). Cefazolin was the most commonly prescribed preoperative and postoperative antibiotic, followed by cefuroxime. With respect to analgesics, paracetamol and tramadol were frequently used in TKR patients. One hundred and seventy six (58.6%) patients received analgesics according to the guidlines recommendations, and 7.8% (n = 23) received more than one analgesic in their postoperative prescription. Conclusion: The low compliance rate with guidelines was observed. The choice and timing of antibiotic, selection of analgesics, and its multiple usage were main identified problems.