Evaluation of Rational Antibiotic Use in Simple Traumatic Wounds (STWs) Based on Thailand Core Indicators in Database of University Hospital

Abstract

In Thailand, Ministry of Public Health (MoPH) enforces core rational drug use (RDU) indicators in hospital. Antibiotics for simple traumatic wounds (STWs) cases, one of rational antibiotic indicator for out-patient department (OPD), must less than 40% of all cases. This study aims to evaluate antibiotic use in STWs cases from database of the university hospital. OPD service data are gathered during January to November 2018. We include totally 13,566 medical records which stated ICD-10 code of STWs through phpMyAdmin program and an entity-relationship (E-R) diagram. Followed the manual, non-rational prescribing of oral and injection antibiotics (ATC-ID code: J01) are 2,549 times (18.8%). It somehow achieves target of MoPH’s indicator. From literature review and expert's opinion, some types of STWs need antibiotics for treatment. When we exclude necessary cases, non-rational antibiotic use is only 11.4%. Beside quantitative data, we explore a list of prescribed antibiotics. A number of drugs is not in accordance with standard guidelines e.g. norfloxacin, ofloxacin, co-trimoxazole, clindamycin, moxifloxacin, and roxithromycin. Inadequate dose and duration of treatment are detected. Amoxicillin-clavulanic acid is the most frequently prescribed, which is not a drug of choice and high cost. Injection antibiotic, such as ertapenem, at OPD is not appropriate when oral formulations are available. Yearly cost of antibiotics for STWs is 274,275 Thai Baht, 21.00% of this cost is non-rational use. This study reflects wastage of scarce resources and leading to increased risk of antimicrobial resistance. Further study needs more information to improve irrational items, dose, range, and route of antibiotics.