Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : June | Volume : 5 | Issue : 3 | Page : 566 - 569

The Pattern of Antibiotic Use in a Family Medicine Department of a Tertiary Hospital in Sokoto, North Western Nigeria

ABDULGAFAR O.JIMOH, EMMANUEL U. ETUK, ZUWAIRA SANI, HUDU A. SHUAIBU

Department of Pharmacology, College of Health Sciences, Usmanu Danfodiyo University Sokoto, Nigeria Health Services Department, Usmanu Danfodiyo University Sokoto, Nigeria Family Medicine Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria Department of Pathology and Microbiology, College of Health Sciences, Usmanu Danfodiyo University Sokoto, Nigeria.

Correspondence Address :
Abdulgafar O. Jimoh
Mailing address: P.O.Box, 2005,
Sokoto, Sokoto State, Nigeria.
E-mail: layidotcom@yahoo.com
Phone: +234 (0)8035950558

Abstract

Background: Antibiotics are substances or compounds which are used to treat infections which are caused by microorganisms including fungi and protozoa. The inappropriate and indiscriminate use of antimicrobial agents can potentially cause a number of problems. The emergence of anti- microbial resistant bacteria, an increased number of patients experiencing adverse drug events and an increase in drug-related costs have been documented.

Objective: This research was conducted with the objective of studying the pattern of antibiotic prescription in a tertiary hospital’s general out patients department.

Methods: A cross sectional, retrospective study was carried out in the Family Medicine Department, at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, from January to June 2008. The records of all the patients who had any courses of antimicrobial agents within this period were isolated and screened and relevant data were extracted by using a prepiloted data collection form and the filled forms were analyzed.

Results: A total of 336 patients, consisting of 146 males (43.45%) and 190 females (56.54%) were enrolled. Among these, 139(41.36%) were in the age group of 21–30 years and 134 (39.88%) had gastro intestinal infections as an indication of antibiotic use. 69 (20.53%) had requested for investigations. The investigations were relevant in 66 (95.65%) and in 57 (82.60%), the samples were taken before the commencement of the antibiotic therapy. Only 27 (39.13%) had got their results before the antibiotic prescription, while 42 (60.86%) had antibiotics prescribed for them without their laboratory results. Among the various antibiotics which were prescribed, 149 (35.83%) were quinolones and 109 (26.29%) were pencillins. The antibiotic combination pattern showed that 56 (44.44%) were given a combination of amoxicillin and metronidazole and that 27 (21.47%) were given a combination of amoxicillin, metronidazole and doxycycline.

Conclusions: Only about one fifth of the patients who were studied had any form of laboratory investigations as a guide for the antibiotic prescription and out of these, only less than half of the results were used as a guide for the antibiotic prescription. The commonest indications for antibiotic use in this study included gastro intestinal infections, genitor-urinary infections, and respiratory tract infections. Quinolones (Ciprofloxacin) were the most commonly prescribed antibiotics in this study.

Keywords

Antibiotic, Prescription Patterns, Laboratory Investigations

How to cite this article :

ABDULGAFAR O.JIMOH, EMMANUEL U. ETUK, ZUWAIRA SANI, HUDU A. SHUAIBU. THE PATTERN OF ANTIBIOTIC USE IN A FAMILY MEDICINE DEPARTMENT OF A TERTIARY HOSPITAL IN SOKOTO, NORTH WESTERN NIGERIA. Journal of Clinical and Diagnostic Research [serial online] 2011 June [cited: 2019 Aug 23 ]; 5:566-569. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=June&volume=5&issue=3&page=566-569&id=1336

Antibiotics are prescribed more by emergency physicians and family practitioners, and patients who are seen in the emergency room and in the family practitioner’s office are more likely to receive antibiotic prescriptions (1). Also, about 85% of all the antibiotic prescriptions are issued by general practitioners (2). Antimicrobial agents are the most commonly used and misused of all the drugs. The inevitable consequence of the widespread use of antimicrobial agents has been the emergence of antibiotic resistant pathogens [3, 4.]. It has been reported that antimicrobials had been used in excess for decades, that only 25% of the patients with respiratory illnesses had anybacterial aetiology and that about 52% of all the antibiotic prescriptions for respiratory illnesses were not clinically indicated at all [5, 6]. As a result, antimicrobial resistance and therapeutic costs have increased significantly [7, 8].

Drug utilization includes the prescribing, dispensing and the ingesting of drugs (9). A drug utilisation study as defined by the WHO, as a structured process which is used to assess the quality of drug therapy by engaging in the evaluation of data on drug prescribing, dispensing and patient use in a given health care environment, against predetermined, agreed upon criteria and standards, with special emphasis on the resulting medical, social,and economic consequences. It seeks to monitor, evaluate and suggest modifications in the prescribing practices with the aim of making the medical care rationale and cost effective. The Drug Utilization 90% (DU90%) index is a simple, inexpensive and flexible method for assessing the quality of the drug prescriptions [10, 11]. Carrying out a drug utilisation study can provide valuable information to the researchers, policy makers and the drug and therapeutics committee members to determine the drug use pattern (12), but a globally accepted dose standard unit is important for the drug utilization studies, particularly if the investigations are performed in different geographical areas and are to be compared (13). The drug utilisation indicators may include prescribing, patient care, and facility indicators, while the defined daily dose is a technical unit for comparing the average recommended daily dose of a drug when it is used for its main indication (14).

Understanding the problem of antimicrobial resistance in a hospital cannot be achieved without the knowledge of the hospital’s pattern of antimicrobial use and therefore, the present study was carried out to achieve the following objectives: To determine the relationship between the pattern of antibiotic usage in a tertiary institution’s outpatients department, To analyze whether relevant investigations were done and used as a guide for the antibiotic prescription and to analyze the prescription as per the antibiotic drug combinations to document any possible drug-drug interaction or adverse drug reaction.

METHODOLOGY
This was a cross sectional retrospective study which was conducted in the Family Medicine Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, north-western Nigeria. The hospital records of the patients who were seen during the period from January to June 2008 were collected and examined. The records of all the patients who had any course of antimicrobial agent were isolated and screened, and relevant data was extracted by using a pre-piloted data collection form.

Among the information which was considered during the data collection were : age, sex, occupation, educational level, indications for antibiotic use, comorbid conditions, whether the investigations were done or not, whether the investigations which were done were relevant for the diagnosis and whether the results were out before the commencement of the antibiotics. The information on the types of investigations and the sensitivity pattern; types, dosages, duration and the drug combinations of the antibiotics which were prescribed were also collected.

All the data were collected, recorded, tabulated and analysed with respect to the objectives of the study.

Results

A total of 336 patients were enrolled in the study.

Demographic Details
There were 146 males (43.45%) and 190 females (56.54%). Among these, the greatest number were in the age group of 21–30 years [ 139 (41.36%) ], followed by the age groups of 10–20 years [ 67 (19.94%) ], 31–40 years [ 64 (19.09%) ], 41–50 years [ 37 (11.01%)], 51–60 years [21 (6.25%) ], 61–70 years [ 5 (1.48%) ] and 71–80 years [ 3 (0.89%) ].

The Distribution of the Indication for Antibiotic Prescription
Among the 336 patients, 134 (39.88%) had gastro intestinal infections as an indication for the antibiotic prescription, followed by 78 (23.21%) who had genitourinary infections, 52 (15.47%) who had respiratory tract infections, 20 (5.97%) who had malaria, 14 (4.16%) who had skin infections, 4 (1.19%) who had cardio vascular diseases and 34 (10.11%) who had other infections.

Investigations
Among the 336 patients, only 69 (20.53%) had their investigations done, while 267 (79.47%) had not done any investigations. Out of those who were investigated, the investigations of 66 (95.65%) were relevant to confirm the main diagnosis for antibiotic use while the investigations were not relevant in 3 (4.34%). 27 (39.13%) had got their results before the antibiotic prescription, while 42 (60.86%) had not got their results before the antibiotic prescription. The microscopic culture and sensitivity (MCS) results showed that 8 (38.09%) showed no growth and that 6 (28.57%) showed Staphylococcus aureus which was sensitive to gentamycin, 0floxacin and ciprofloxacin. Among the various antibiotics which were prescribed, 149 (35.83%) were quinolones and 109 (26.29%) were penicillins. The details of the cultures and the sensitivity test results are shown in (Table/Fig 1).

The Classes of the Antibiotics which were Prescribed
Altogether, 438 drugs were prescribed in the study population. Among the antibiotics which were prescribed, the commonest class was quinolones [149 (35.83%) of the total drugs], followed by penicillins [109 (26.20%)]. The details regarding the classes of the antibiotics which were prescribed are listed in (Table/Fig 2).

Discussion

Out of the 336 patients who were selected for this study, the highest number of patients was found to be between the age group of 21 to 30 years and the lowest number was between the age group of 71 to 80 years.

There were more females than males, with a significant number of them being not gainfully employed. Peptic ulcer disease and enteric fever were the most common diagnoses, followed closely by respiratory tract infections, urinary tract infections, and pelvic inflammatory disease. The highest co morbid condition was malaria, others included diabetes mellitus, hypertension, cardiac failure and arthritis.

It is important to note that just about one fifth of the patients who were studied underwent any form of laboratory investigation and a majority of the investigation results were either not returned by the patients or were not recorded in the case notes, or the documented results were not relevant (an example is, when a patient presented with malaria and respiratory tract infection, an antibiotic was prescribed but the investigation which was done was the blood film forthe malaria parasite). This was so concluded, because despite the fact that the data analysis revealed that over 95% of the investigations which were done were relevant for the diagnosis, there was not enough data on the sensitivity pattern of the organisms.

This study also revealed that despite the fact that the samples were taken before the commencement of the antibiotics in more than 80% of the patients who had their investigations done, only less than 40% of such results were used as a guide for the antibiotic prescription.

Ciprofloxacin was found to be the most commonly used antimicrobial agent in this study, it accounted for almost one third of the antibiotic prescriptions within the study period. Amoxicillin and metronidazole followed closely. Gentamycin and septrin were the least prescribed. This may not be unconnected with the toxicity which was associated with aminoglycosides and the emergence of resistance strains and the adverse drug reactions which were associated with septrin.

The use of trade names instead of generic names was very rampant among the prescribers; this may not be unconnected with the immense pressure which was mounted by the pharmaceutical company representatives on the prescribers and the frequent inducement or entertainment in the form of gifts.

There were no reports about drug-drug interactions or adverse drug reactions.

The international differences in the hospital use of antibiotics were not in the intensity of the use but in the prescription preferences (15). The wards of similar medical specialities used similar total amounts of antibiotics but from different pharmacological subgroups and thus, with different microbiological activities (16). Ideally, the selection of the antibiotics should be based on the microbiological data on the bacteria sensitivity and on the prevalence of resistance in the respective hospital.

In a similar study which was done to evaluate the current practice pattern of the antibiotic prescription rate in children who were diagnosed viral respiratory tract infections among different specialty health care providers, it was reported that the unnecessary use of antibiotics not only contributed to the rising cost of the outpatient treatment of RTIs, but it was also associated with increasing adverse drug effects and the rapid spreadof antibiotic-resistant organisms in the community. In another study which was done to investigate the Influence of the prescription patterns in the general practice on anti-microbial resistance, it was concluded that there was a low total prescription volume of antibiotics in Norway as compared to other countries. However, there was still a great potential for reducing the unnecessary antibiotic prescribing for the most common respiratory illnesses (17). In yet another study which was done to examine the antibiotic prescription pattern and the related cost in a tertiary hospital in Ilorin-Nigeria and Haifa-Israel, it was reported that the antibiotic prescription habits of doctors in these developing countries called for concern and that a lot of money could be saved without compromising the quality of care, if policies were formulated and promoted on the rational antibiotics prescription in developing countries like Nigeria. These should focus on promoting expenses and infectious control, with the rational antibiotic prescription and utilization being aimed at minimizing the future emergence of bacterial resistance [18,19]. A poor compliance with the current treatment guidelines was observed in a study of antibiotic prescription patterns in hospitalized patients with nursing home–acquired pneumonia in the city of Buffalo, New York, contributing to the overall factors whichwere responsible for antibiotic resistance (20). A study on the pattern of antibiotic prescription in the management of endodontic infections amongst Spanish oral surgeons concluded that the use of antibiotics for minor infections or in some cases, in patients without infections could be a major contributor to the world problem of antimicrobial resistance (21).

CONCLUSION AND SUMMARY OF FINDINGS
This study was able to reveal the following findings:

A majority of the patients in this study were between the age group of 21 to 30 years and a high percentage of the patients were females and they were not gainfully employed. Peptic ulcer disease, typhoid fever, respiratory tract infections and genito-urinary tract infections were the most frequent indications for antibiotic use in this study. Malaria was the highest co-morbid condition. Only about one fifth of the patients who were studied had any form of laboratory investigations and only less than a half of such results were used as a guide for the antibiotic prescription. Ciprofloxacin was found to be the most commonly used antimicrobial agent in this study. Amoxicillin and Metronidazole followed closely. Gentamycin and the Sulphonamide Septrin were the least prescribed antibiotics. The incessant use of trade names instead of generic names in the prescriptions was also highlighted. The lack of proper documentation was found to be a compounding factor. Amoxicillin with Metronidazole was the most commonly used antibiotic combination. No adverse drug reaction was reported in this study.


Conclusion

APPENDIX I
Questionnaire for pattern of antibiotic use in a family medicine department of a tertiary hospital in sokoto, north western nigeria (January to June 2008) Section A: Demographic data 1. Serial number 2. Age 3. Sex 4. Occupation 5. Address 6. Tribe 7. Religion 8. Educational level Section B: Antibiotic use pattern 9. Indication for antibiotic use (diagnosis) 10. Co-morbid condition(s) 11. Were investigation(s) done? 12. Type(s) of investigations done 13. Is the investigation(s) done relevant to the indication for antibiotic use? 14. Type(s) of microorganism isolated 15. Sensitivity pattern 16. Were results out before antibiotic prescription? 17. Type(s) of antibiotic prescribed 18. Dosage and duration of antibiotic prescribed 19. Type(s) of antibiotic combination 20. Type(s) of other drug combination

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