Drug utilization evaluation of aminoglycosides, gentamicin and amikacin: A retrospective study in pediatric patients at secondary care public hospital

Background: Antibiotics are potent drugs which are usually used in the treatment of bacterial infections. Aminoglycosides are powerful, broad spectrum antibiotics that exhibits both gram positive and gram-negative coverage and are often used for treatment of bacterial infections in the pediatric patients. Gentamicin and Amikacin are broad spectrum aminoglycoside antibiotics with bactericidal activity and is widely used in the treatment of bacillary infections in infants and children. Clinical effects of gentamicin-related toxicity such as ototoxicity, nephrotoxicity is well known. The incorrect use of aminoglycosides has deleterious effects such as of nephrotoxicity and ototoxicity and can result in the development of resistant pathogens. Therefore, drug utilization evaluation of aminoglycosides can significantly improve their usage. Methods: This study is a retrospective pilot study carried out in a secondary care public hospital, Ooty to understand the Aminoglycoside usage in the pediatric population. A total of 133 cases were collected with aminoglycoside usage during the period of one year from January 2018 to December 2018. The data was collected in the structurally designed data collection form which included patient demographic data such as name, age, gender, body weight, treatment plan including drug, dose, duration, frequency and route of administration, length of hospitalization along with laboratory data such as, microbiological culture sensitivity and renal function test. Results: Among 133 cases, the aminoglycoside commonly prescribed was gentamicin (100) and amikacin (34) which constitutes for 74.6 and 25.4 percentages respectively. The Defined Daily Dose of Gentamicin and Amikacin was calculated and compared with WHO DDD value which was found to be comparable. The DDD per patient and DDD per 1000 patients were calculated respectively to understand the drug utilization pattern of aminoglycosides. The study findings suggested that Aminoglycosides are widely used in Infants and Children and was commonly prescribed for Lower Respiratory Tract Infections and Upper Respiratory Tract Infections, followed by Fever, Viral Fever, Febrile Seizures, Tonsillitis, Acute Gastro Enteritis, Adenoiditis and Urinary Tract Infections. Once daily was more commonly prescribed followed by Twice daily followed by combination therapy. Among the 100 cases of gentamicin prescribed, a total of 18 prescriptions were found to be stopped earlier with 1 day (n=10) or 2 days (n=08). Among the total 39 cases of renal function test done, the patients (n=11) prescribed with Amikacin constitutes about 32.4% and the patients (n=29) prescribed with gentamicin constitutes around 29% respectively.

Conclusion: The study findings concluded that Gentamicin and Amikacin usage was appropriate in pediatric population with reference to the DDD values.