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Antibiotics are widely used worldwide and their inappropriate prescription leads to emergence of
multi-drug resistant organisms, increased morbidity and mortality. Rational use of antibiotics is the
key to reducing the development of resistant organisms. Thus the objective of this study was to
ascertain the use and appropriateness of antibiotics used in medical wards at a selected tertiary care
institution using available national guidelines.
A descriptive cross sectional study was carried out on the patients prescribed antibiotics in three
general medical units. A random sample of patient records (n=543) over a period of 4 months was
analyzed. The regimes were assessed for concordance with the guidelines of Sri Lanka Medical
Association (SLMA) and the Health Sector Development Programme (HSDP).
The commonest indications toprescribe antibiotics were lower respiratory tract infections (LRTI)
(n=235, 43%), urinary tract infections (UTI) (n=60,11 %) and infective exacerbation of bronchial
asthma (n= 45, 8.3%). The commonest first antibiotic prescribed for LRTI was co-amoxiclav (n=98,
41.7%) which was given in combination in18/98 (18.36%) of episodes, while ciprofloxacin was the
first choice in 46.6% of UTIs. For LRTIs the prescribed antibiotics showed a greater concordance
with HSDP guidelines (n=157, 66.8%) compared to SLMA guidelines (n=99, 42.1%). The
concordance with SLMA guidelines for lower UTIs was only 11.8% (n=4) while that for
pyelonephritis was 38.5% (n=10). Co-amoxiclav was the first antibiotic prescribed for infective
exacerbation of bronchial asthma in 48.9% (n=22) for which there were no separate guideline in either
the SLMA or HSDP. The antibiotic use in LRTI was incorrect due to inappropriate-dose and route of
the drug (n=20, 8.5%), wrong choice ofthe drug (n=13, 5.5%) and wrong combinatiop of drugs (n= 13,
5.5%) according to the HSDP guidelines. No statistically significant difference was found between
individual unit practices.
Antibiotic prescriptions need to be improved to optimize use and reduce development of resistance.
Development and effective implementation of a National Antibiotic Policy would be a major step in
ensuring appropriate use of antibiotics.
