COMPARATIVE STUDY ON PROPHYLACTIC USE OF AMOXICILLIN AND CLAVULANIC ACID IN COMBINATION VS CEFTRIAXONE IN NEUROSURGERY WARD OF A TERTIARY CARE HOSPITAL WITH ASSESSMENT OF RESISTANCE RATE IN NEUROSURGERY TO ANTIMICROBIALS

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ABOUT AUTHORS:
Neehar Dixit, Arun Kumar, Prashant mathur, Preeti kothiyal
Department of clinical pharmacy
Division of Pharmaceutics
SGRRITS, Patel Nagar
Dehradun, 248001
Uttarakhand, India
neehar.dixit007@gmail.com

ABSTRACT
Antimicrobial agents are among the most commonly prescribed drugs and account for 20% of the hospital pharmacy budget. The present study was designed to observe and compare the prophylactic use of antibiotics (amoxicillin+clavulanic acid vs ceftriaxone) in neurosurgery ward of a tertiary care hospital with assessment of resistance rate in neurosurgery to antimicrobials. Total no of 250 patients were included in the study, in this study inclusion of 232 patients  were receiving amoxicillin+clavulanic acid or Ceftriaxone for prophylaxis in neurosugery. The following parameters were included- reduction of fever, reduction of exudates, depression or disappearance of pathogenic bacteria, overall clinical improvement, complications and length of hospitalization stay. Test of significance of two real ratios was applied and the value of Z indicated (Z=36) which is highly significant hence two ratios are not equal. It implied that ceftriaxone was better than amoxicillin+clavulanic acid. Present study conclude that the resistance rate of penicillins is higher than ceftriaxone in neurosurgery ward. Data  also shows that ceftriaxone is the better choice of treatment and it reduces the hospitalization stay of patients and lead to less burden on patient.

REFERENCE ID: PHARMATUTOR-ART-2052

INTRODUCTION:
Antimicrobial agents are among the most commonly prescribed drugs and account for 20% of the hospital pharmacy budget(1). Unfortunately, the benefits of antibiotics to individual patients are compromised by the development of bacterial drug resistance[2]. Resistance is a natural and inevitable result of exposing bacteria to antimicrobials[3]. Therefore, the study was conducted to see the effect of two antibiotics namely augmentin and ceftriaxone. Augmentin is an antibiotic of the penicillin type. It is effective against different microorganism such as H. influenzae, N. gonorrhea, E. coli, Pneumococci, Streptococci, and certain strains of Staphylococci[4]. Addition of clavulanic acid to amoxicillin in augmentin enhances the effectiveness of this antibiotic against many other bacteria that are ordinarily resistant to amoxicillin. Amoxicillin/clavulanic acid (INN) or co-amoxiclav (BAN) is a combination antibiotic consisting of amoxicillin trihydrate, a β-lactam antibiotic, and potassium clavulanate, a β-lactamase inhibitor[5]. This combination results in an antibiotic with an increased spectrum of action and restored efficacy against amoxicillin-resistant bacteria that produce β-lactamase.Ceftriaxone (INN)is a third-generation cephalosporin antibiotic. Like other third-generation cephalosporins[7], it has broad spectrum activity against Gram-positive and Gram-negative bacteria[8]. In most cases, it is considered to be equivalent to cefotaxime in terms of safety and efficacy[9].

MATERIAL & METHODS:
A total no 250 patients were included in the study. Different types of organism were studied. Resistant rate by antibiotic susceptibility testing was observed. Observations were made for ten criteria under this study.viz.reduction of fever, reduction of exudates, depression or disappearance of pathogenic bacteria, Overall clinical improvement, complication, rate of infections , rate of shunt removal, length of hospitalization, adverse effect of drugs and sensitivity of different organism were also recorded. Prospectively recorded data included: patient demographics; laboratory data and value of comorbidity conditions, date of hospital admission, date of surgery; preoperative antisepsis and drapes used during surgery; previous hospitalisation within one year.If a nosocomial infection occurred, aetiology, susceptibility pattern of the isolate, antibiotic therapy and outcome were recorded.  Patient above 16 yrs  were selected for the study . Only the first episode of bacterial postoperative infection was included in the analysis of outcomes. Adverse effects, as determined by analysis of both clinical and laboratory data, were assessed for each patient included in the study. The two parameters i.e primarily rate of infections and secondary crude mortality, rate of shunt removal, rate of remote infections (pneumonia and urinary tract infections), length of hospitalisation,  and adverse effects of drugs used for prophylaxis were selected.

Statistical analysis:
Test of significance of two real ratios was applied to see the efficacy of the test and to find out the better drug.

Microbiological analysis:
Antibiotic susceptibility test and resistance rate was analyzed in different patients.

Results:-
As discuss in table no. 1 total 232 patients were randomly allocated for treatments. In each group 116 patients were selected. Augmentin and ceftriaxone was prophylactically administered in respective groups. Following neurosurgeries were selected for the study i.e. SDH (sub dural haemmorage), EDH (epi dural haemmorage), craniotomy ,shunt, bone flap and head injury.

Types of surgery

Group A (116 patients) Amoxicillin+Clavulanic acid Treated

Group B (116 patients)

Ceftriaxone Treated

SDH

41

25

EDH

25

21

CRANIOTOMY

14

20

SHUNT SURGERY

15

23

LUMBAR

PUNCTURE

21

27

Table no 1 : Showing no. of patients include in the study.

Parameters

DrugA (amoxicillin+clavulanic            acid)

Drug B

(ceftriaxone)

Reduction of fever

48 out of 64 patients

22 out of 48 patients

Reduction of exudate

48 patients

68 patients

Rate of infection

28 patients

18 patients

Length of hospitalization stay

2436 days

20 days per patient

1740 days

14 days per patient

Rate of shunt removal

315 days

I5 patients

322 days

23 patients

Overall clinical improvement

28 patients

44 patients

Adverse effect

0 patient

2 patients

Table no 2.Demographic and clinical characteristics at study inclusion of 232 patients receiving amoxicillin+clavulanic acid or Ceftriaxone for prophylaxis in neurosugery. Test of significance of two real ratios was applied and the value of Z indicated (Z=36) which is highly significant hence two ratios are not equal.

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