A prospective observational study on prescription pattern and drug utilization pattern of fluoroquinolones in a tertiary care hospital.

Dr. Anand  Acharya; Dr . Gopi  Lunavath; Dr. Nethala Ravi  Kumar

doi:10.51168/sjhrafrica.v6i12.2339

Authors

Dr. Anand Acharya Dean and Professor, Department of Pharmacology, Konaseema Institute of Medical Sciences, Amalapuram, Andhra Pradesh, India.
Dr . Gopi Lunavath Assitant Professor, Department of General Medicine, Government Medical College and General Hospital, Bhadradri Kothagudem, Telangana, India.
Dr. Nethala Ravi Kumar Associate Professor, Department of Pharmacology, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chattisgarh, India.

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2339

Keywords:

Fluoroquinolones, Prescribing patterns, Drug utilization research, Antimicrobial resistance, Adverse drug reactions, Antimicrobial stewardship, Tertiary care hospital

Abstract

Background:

Fluoroquinolones (FQs) are widely prescribed broad-spectrum antibiotics, yet their extensive use contributes to antimicrobial resistance (AMR) and raises important safety concerns. This study prospectively evaluated FQ prescribing and drug-utilization patterns in a tertiary care hospital to identify gaps requiring stewardship attention.

Methods:

This prospective observational study included 300 adult patients who received FQs across multiple clinical departments. Information was extracted from medical records using a structured form documenting demographics, clinical details, FQ type, dose, indication, duration, and outcomes, including adverse drug reactions (ADRs). Prescriptions were assessed for appropriateness against institutional guidelines, and data were analyzed descriptively.

Results:

A total of 300 adult patients receiving fluoroquinolone therapy were included. The mean age was 54.2 ± 12.5 years; 165 (55.0%) were males, and 135 (45.0%) were females. Diabetes mellitus was observed in 126 (42.0%) patients, hypertension in 114 (38.0%), and chronic kidney disease in 51 (17.0%). Ciprofloxacin was most frequently prescribed [144 (48.0%)], followed by levofloxacin [111 (37.0%)] and ofloxacin [45 (15.0%)]. Urinary tract and lower respiratory tract infections were the leading indications. Empirical therapy was used in 216 (72.0%) cases, while culture-guided therapy was documented in 84 (28.0%). Overall, 135 (45.0%) prescriptions were appropriate, whereas 165 (55.0%) were inappropriate, mainly due to non-bacterial indications or prolonged duration. Adverse drug reactions occurred in 36 (12.0%) patients, predominantly gastrointestinal symptoms. Culture reports showed high fluoroquinolone resistance in E. coli (65.0%) and Klebsiella species (55.0%).

Conclusion:

The study demonstrates substantial inappropriate FQ prescribing, primarily driven by empirical therapy and poor adherence to guidelines. Strengthening antimicrobial stewardship is essential to reduce resistance and enhance patient safety.

Recommendations:

Implement department-specific stewardship audits, restrict empirical FQ initiation, reinforce guideline-based prescribing through regular training, and integrate culture-guided therapy to optimize antibiotic use and curb resistance development.

Author Biographies

Dr. Anand Acharya, Dean and Professor, Department of Pharmacology, Konaseema Institute of Medical Sciences, Amalapuram, Andhra Pradesh, India.

MBBS, MD (Pharmacology), currently serves as Dean and Professor, Department of Pharmacology, at the Konaseema Institute of Medical Sciences & Research Foundation (KIMS&RF), Amalapuram, Andhra Pradesh, India. A distinguished academician, researcher, and medical education leader, he has been pivotal in transforming KIMS&RF from its formative phase into a premier medical institution with over 200 undergraduate and 100 postgraduate seats.

With more than 18 years of teaching and administrative experience, Dr. Acharya has held several leadership positions, including Vice Principal, Principal, Chief Warden, Member Secretary of Institutional Ethics and Animal Ethics Committees, and is an approved PhD Guide under Dr. NTR University of Health Sciences, Vijayawada. His visionary leadership has significantly enhanced the institution’s academic quality, clinical exposure, research infrastructure, and postgraduate training standards.

He has completed prestigious national faculty development programs such as the Revised Basic Course Workshop (rBCW), Advanced Course in Medical Education (ACME), and National Teacher Training Course (NTTC, JIPMER, Puducherry). He also serves as Coordinator for Pharmacovigilance and Materiovigilance Programs under IPC–PvPI and MoHFW, Government of India, contributing actively to national drug safety and regulatory initiatives.

A prolific academician, Dr. Acharya has authored and co-authored more than 100 scientific publications in reputed national and international indexed journals. His wide-ranging research covers toxicology, pharmacovigilance, antimicrobial resistance, endocrinology, neuropharmacology, and clinical pharmacology. His recent studies include long-term analyses of pyrethroid, paraquat, and chlorpyrifos poisoning, investigations into antimicrobial resistance trends, and predictive models for treatment outcomes in dermatological and toxicological emergencies.

Dr. Acharya’s professional interests include clinical pharmacology, toxicovigilance, rational drug use, pharmacovigilance systems, and innovations in medical education technologies. He continues to mentor numerous postgraduate and undergraduate researchers while playing an integral role in curriculum reform, ethics governance, and institutional academic advancement.ORCID iD: https://orcid.org/0009-0000-7967-9092

Dr . Gopi Lunavath, Assitant Professor, Department of General Medicine, Government Medical College and General Hospital, Bhadradri Kothagudem, Telangana, India.

Dr. Gopi Lunavath, MBBS, MD (General Medicine), is an Assistant Professor in the Department of General Medicine at Government Medical College and General Hospital, Bhadradri Kothagudem, Telangana, India. He began his medical education with MBBS at Dr. Pinnamaneni Siddhartha Medical College, Gannavaram, joining in 2003 and completing the course in 2008. He later pursued MD in General Medicine at GSL Medical College, Rajahmundry, joining in 2018 and completing the program in 2021.

Before entering academic service, Dr. Gopi Lunavath worked as a Civil Assistant Surgeon from 2014 to 2023 regularly, gaining extensive experience in clinical medicine, patient management, and government healthcare delivery. His professional interests span acute and chronic non-communicable diseases, infectious diseases, and evidence-based internal medicine.

He is actively engaged in teaching undergraduate and postgraduate students, providing dedicated clinical services, and contributing to comprehensive patient care in a busy tertiary-care government hospital setting. ORCID iD: https://orcid.org/0009-0007-8045-3921.

Dr. Nethala Ravi Kumar, Associate Professor, Department of Pharmacology, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chattisgarh, India.

is an Associate Professor in the Department of Pharmacology at Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, India. He holds a PhD in Medical Pharmacology, with academic and research interests focused on drug safety evaluation, experimental pharmacology, and the translation of pharmacological evidence into clinical practice. He is actively involved in teaching pharmacology to undergraduate and postgraduate medical students, guiding research projects, and strengthening departmental academic activities. His work reflects a commitment to advancing rational therapeutics and fostering high-quality medical education. ORCID iD: https://orcid.org/0000-0002-9231-6947

References

Drlica K, Malik M, Kerns RJ, Zhao X. Quinolone-based antibiotics: mechanisms of action and bacterial resistance. Antimicrob Agents Chemother. 2008;52(2):385-392. https://doi.org/10.1128/AAC.01617-06

Reddy DN, Sudhakar K, Suresh P, Rambabu B, Vijayalakshmi B. A study on the drug utilization pattern of antibiotics in a tertiary care hospital. J Clin Diagn Res. 2013;7(8):1618-1621.

Centers for Disease Control and Prevention (CDC). Antibiotic resistance threats in the United States, 2019. Atlanta, GA: CDC; 2019.

World Health Organization (WHO). Antimicrobial resistance: global report on surveillance 2014. Geneva: WHO Press; 2014.

US Food and Drug Administration (FDA). FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects. Silver Spring, MD: FDA; 2016.

Tanne JH. FDA strengthens warnings about fluoroquinolones. BMJ. 2018;361:k2115.

Al-Homaidan HT, Abdel-Fattah MM, Al-Muneef MA, et al. Utilization and prescribing patterns of antimicrobials in a university hospital in Saudi Arabia. Ann Clin Microbiol Antimicrob. 2011;10:35.

8)Goff DA, Kullar R, Forrest GN, et al. Society of Infectious Diseases Pharmacists (SIDP) position paper: recommended key characteristics of a successful antimicrobial stewardship program. Clin Infect Dis. 2014;59(suppl 3): S246-S253.

Al-Homaidan HT, Abdel-Fattah MM, Al-Muneef MA, et al. Utilization and prescribing patterns of antimicrobials in a university hospital in Saudi Arabia. Ann Clin Microbiol Antimicrob. 2011;10:35.

O'Neill J. Tackling drug-resistant infections globally: final recommendations. The Review on Antimicrobial Resistance; 2016.

Reddy DN, Sudhakar K, Suresh P, Rambabu B, Vijayalakshmi B. A study on the drug utilization pattern of antibiotics in a tertiary care hospital. J Clin Diagn Res. 2013;7(8):1618-1621.

Abla N, Al-Azzam S, Al-Bataineh M, et al. Safety of fluoroquinolones: a prospective surveillance in a university hospital. Curr Clin Pharmacol. 2015;10(3):250-255. https://doi.org/10.12785/jhs/20152602

Dyar OJ, Beović B, Pulcini C, et al. ESCMID guidelines for the development of an institutional antimicrobial stewardship program (ASP) of a hospital. Clin Microbiol Infect. 2017;23(2):79-93.