We observed that majority of cases in this sample were between the age group of 21 and 50 years. This is the usual trend as it is the productive age group that is actively involved in socioeconomic activities, making them vulnerable to diseases, which may needs surgical interventions.
Most of the hospitalizations were due to renal calculi, abscess, and acute abdomen. This is because our study center is a referral hospital for the district. A large number of acute abdomen cases indicate insufficient healthcare facilities at the primary and secondary health care centers of the region. Moreover, excess cases of renal calculi and abscess might be due to lack of awareness to get early medical help since this region does not belong to an endemic zone for renal calculi. Moreover, poverty may also be a reason for late arrival of the cases since the region is relatively less developed on developmental indices in comparison with other districts of the state.[11
In the studied population, polypharmacy was observed as drugs per prescription were high (5.1), which contain antimicrobials in most of the cases (38%), followed by NSAIDs (19.6%), and antihistamines and drugs were given preferably by intravenous route. Kumari et al
] at Lucknow in north India and Bapna et al
] in South India also observed polypharmacy in their respective regions. Sometimes, more number of drugs is required for the management of a few conditions, but our findings suggests polypharmacy as a routine practice in the region. Reasons may include getting early relief in the diseases.
Among antimicrobials, preferred drugs were ciprofloxacin (22.65%); metronidazole (21.65%), 3rd
generation cephalosporins, gentamicin, and ampicillin. Majority of drugs were branded drugs and used without culture and sensitivity tests. Use of two antimicrobials agents was also common. Vaccheri et al
] in their study, which was conducted in Italian hospitals, observed 18% antimicrobial use and combination of penicillin with β-lactamase inhibitors followed by fluoroquinolones and third-generation cephalosporins was common. They also observed more use of antimicrobials in surgical units in comparison with medicine units and higher number of 3rd
generation cephalosporins for surgical prophylaxis.
Khan et al
] observed use of cefixime and combination of amoxicillin with clavulanic acid followed by gentamicin, azithromycin, ciprofloxacin, and metronidazole was common in North India. They also found that use of antimicrobial monotherapy and two-drug antimicrobial therapies were also common. Giri et al
] in Nepal found that culture and sensitivity was done only in 32.4% cases who were suffering from surgical site infection and that use of combination of ampicillin with cloxacillin was common. This was followed by metronidazole, ampicillin, gentamicin, and cefuroxime. Al Shimememri et al
] in their study observed ceftrixone as the most common drug without use of culture and sensitivity tests. Thomas et al
] also observed use of antimicrobials without culture and sensitivity as common practice in primary and tertiary healthcare system in India.
Surgical procedures needs antimicrobial coverage to avoid postoperative infective complications, but it is observed that unnecessary use of antimicrobials is also common. For surgical prophylaxis, international guidelines indicates that use of 1st
or at the most 2nd
generation cephalosporins is suitable, rather 3rd
generation and other higher antimicrobials are also commonly used for the purpose.[19
] There are many reasons for such a type of trend such as the desire to avoid postoperative complications, to get early relief, claim of lack of time for of investigations or lack of sufficient microbiological laboratory infrastructure, and belief and experience of surgeon over a number of antimicrobials.
In the present study, branded drugs were preferred by the surgeons, and dose and frequency of drugs were inappropriate in some cases. Such trend can affect the regional population.