Dr. Afreen Nasir, PharmD Internship

1. Journal Club
AFREEN NASIR
PharmD intern
Acharya & BM Reddy College of Pharmacy
Bengaluru
Department of Pharmacy Practice, Acharya & BM Reddy College of Pharmacy 1

2. Drug Utilization Pattern in Adult Medical Intensive Care Unit of a Tertiary
Care Hospital
Department of Pharmacy Practice, Acharya & BM Reddy College of Pharmacy 2
Thomas A, Adake U, Sharma A, Raut A
Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune,
Maharashtra, India
• Published in Journal : CHRISMED Journal of Health and Research.
• Year : Jan-Mar 2019| Volume : 6 | Issue : 1 | Page No. : 35-38.
• DOI: 10.4103/cjhr.cjhr_45_18
ABOUT THE JOURNAL
• It is a publication of Christian Medical College, Ludhiana Society.
• It is a peer-reviewed Quarterly Journal with both online and print versions.
• It is an Open Access journal.
• It does not charge for submission, processing or publication of manuscripts.
• It covers technical and clinical studies related to health, ethical and social issues in field of Medical, Nursing, Dental,
Allied Health.
• The journal is indexed with DOAJ, Index Copernicus.
• Abbreviation: CHRISMED J Health Res.
Impact Factor h - index Publisher Country ISSN
0.1 6 Medknow, part of Wolters Kluwer Health India 2348-3334, 2348-506X

3. Department of Pharmacy Practice, Acharya & BM Reddy College of Pharmacy 3
Abstract :
Aim: To evaluate the drug utilization pattern in terms of Defined Daily Dose (DDD) in adult Medical Intensive Care
Unit.
Methodology: In this prospective study conducted over a period of 8 months, data pertaining to all adult (age ≥18
years) patients’ demography, diagnosis, treatment, and laboratory investigation were collected. The drugs were
categorized by anatomical therapeutic classification, and their DDD was calculated.
Result: A total of 452 patients were evaluated, of which 62.6% were males. The most common reason for
hospitalization was cardiovascular disorder (21.4%). An average of 9.9 drugs was prescribed per patient. Nearly 52%
of drugs were administered parenteral, 43% were oral. The most common drugs prescribed were pantoprazole,
ondansetron, aspirin and most common antimicrobials were ceftriaxone followed by piperacillin + tazobactam and
metronidazole.
Conclusion: Drug utilization produces an important impact on quantitative data for ICU patients and should be
conducted regularly so as to understand the drug consumption as well as for protocol implementation to improve the
quality of health care.
Keyword: Defined Daily Dose, Prospective study, Anatomical therapeutic Chemical classification system.

4. Introduction:
• WHO defines Drug Utilization Evaluation as “marketing, distribution, prescription, and use of drugs in a society,
with special emphasis on the resulting medical, social, and economic consequences”.
• It provide insights into different aspects of drug use.
• Defined Daily Dose (DDD) is the assumed average maintenance dose per day for a drug used for its main
indication in adults.
Objectives:
• To understand the pattern of drug use and evaluating the drug utilization pattern in terms of DDD in adult medical
ICU (MICU).
Department of Pharmacy Practice, Acharya & BM Reddy College of Pharmacy 4

5. Methods:
• Study site: 15-bedded adult medical intensive care unit of Tertiary care hospital, Pune, Maharashtra, India.
• Study design: Prospective study
• Study duration: 8 months ( Aug 2016-Mar 2017)
• Inclusion criteria: Patients above 18 years admitted in MICU of Tertiary care hospital, Pune, Maharashtra, India.
• Sample size: 452 adult patients were admitted in 15-bedded MICU during the study period.
• Data collection: Modified patient profile form was developed to collect demographic, diagnosis, treatment, lab
investigation details.
• Data management:
 Data obtained were assessed for the age and gender distribution, reason for hospitalization, total number of drugs,
drug class, indication, dose, and route of administration.
 The drugs were classified based on ATC and DDD was calculated.
 DDD/100 bed days was calculated using the formula:
Department of Pharmacy Practice, Acharya & BM Reddy College of Pharmacy 5

6. Results:
Distribution of patients based on gender
Age distribution: Mean age of patients was 57
146 (32%) of total patients were above 65 years.
Reasons for admission
Department of Pharmacy Practice, Acharya & BM Reddy College of Pharmacy 6
Gender No. of patients %
Male 283 62.6
Female 169 37.3
Diseases No. of
patients
%
CVD 97 21.4
Respiratory
disorder
95 21
CNS disorder 94 20

7. Results:
Distribution of patients based on comorbidities
Distribution of patients based on route of administration
Department of Pharmacy Practice, Acharya & BM Reddy College of Pharmacy 7
Comorbidities No. of patients
HTN 181
Diabetes mellitus 128
Ischemic heart disease 85
CKD 39
COPD 21
Route of administration No. of drugs
Parenteral 2329
Oral 1913
Nebulization or topical 225
• Average length of stay per patient
was 4.8 days.
• A total of 4467 medication were
prescribed during the study
period in ICU.
• An average of 9.9 drugs was
prescribed per patient.

8. Department of Pharmacy Practice, Acharya & BM Reddy College of Pharmacy 8
Results:
ATC classification FDC
• Of total prescribed drugs, 268 (6%)
was given as fixed drug
combination (FDC).
• The commonly prescribed FDCs
were piperacillin-tazobactam (80)
followed by ipratropium
bromide/levosalbutamol (71) and
amoxicillin-clavulanic acid (15).

9. Department of Pharmacy Practice, Acharya & BM Reddy College of Pharmacy 9
Results:
DDD/100 bed days
Drugs DDD/100 bed days
Pantoprazole 25.7
Paracetamol 25
Atrovastatin 22.9
Ondansetron 21.2
Furosemide 20.2
Ceftriaxone 26
Metronidazole 15.7
Piptaz 12.2
Azithromycin 10
Meropenem 4.18

10. Department of Pharmacy Practice, Acharya & BM Reddy College of Pharmacy 10
Discussion
• This study observed that male were admitted more compared to female which was similar to study done by Patel et al.
• In this study common comorbid conditions were HTN (40%) & diabetes mellitus (28%) which was similar to study
done by Kaur et al., which provided evidence to existing increasing status of those condition as burden of
developing and developed countries.
• The average length of stay of patient was 4.8 days which was similar to Patel et al. Prolonged stay in the
ICU increases the overall costs & consumes more resources, increases the risk of ADR. Therefore, early
discharge from ICU plays a major role in minimizing economic burden.
• Study done by Patanaik et al., Balaji et al. also documented that drugs were commonly administered
through parenteral & oral routes. Since patients admitted in ICU require rapid therapeutic intervention,
parenteral dose can provide immediate onset of action.
• Study done by Balaji et al. & Patanaik SK et al. also documented that Pantoprazole was commonly prescribed drug in
ICU because it suppresses gastric acid secretion, prevents upper GI bleeding and promotes mucosal healing.
 Study by Mohebbi L et al. observed that between 75% and 100% of ICU patients had stress-related mucosal disease
within 24 hr of admission, as a result administration of acid suppression therapy for stress ulcer prophylaxis in the ICU
was well recommended to prevent GI bleeding.

11. Department of Pharmacy Practice, Acharya & BM Reddy College of Pharmacy 11
Discussion
• In this study use of anti-infective as prophylaxis was a higher accounting (14%) of total drugs prescribed. It had
been documented by Dasgupta et al. that the incidence of nosocomial infection in ICU was about 2–5 times
higher than in the general inpatient hospital population.
Mythri et al. study observed that 17.7% incidence of nosocomial infection could be seen in MICU patients
which could lead to increase number of anti infective prescription.
• Of total drugs prescribed, only 6% were FDC. Shah et al. had documented about 70.83% of FDC
prescription. In this study, there were minimal use of FDCs reflecting the rational use of drugs.
• This study observed that DDD of pantoprazole and furosemide was 25.7 and 20.2 DDD/100 bed-days, which
was less than a study reporting 48.9 and 23.7 DDD/100 bed-days. DDD of ceftriaxone was 26 DDD/100
bed-days which was more compared to study done by Patanaik et al. which was 23.7 DDD/100 bed-days

12. Department of Pharmacy Practice, Acharya & BM Reddy College of Pharmacy 12
Limitations
• Ethical approval details were not mentioned.
• There were no exclusion criteria.
• Interpretation of DDD was not done.
Limitations mentioned in the article:
• The data pertaining to their study couldn’t be generalizable to critical care units with a substantial different
means of the severity of illness or markedly different patient types such as surgical, neurological ICUs,
nonteaching hospital.
• They had not assessed the cost of drug therapy which would have helped to understand the financial burden of
ICU patients.

13. THANK YOU
Department of Pharmacy Practice, Acharya & BM Reddy College of Pharmacy 13