DRUG UTILIZATION PATTERN IN HOSPITALISED PATIENTS WITH ACUTE UNDIFFERENTIATED FEBRILE ILLNESS AT A TERTIARY CARE TEACHING HOSPITAL

Authors

1. Seshla Sadanandan
   ¹Department of Pharmacology, Dr Vithalrao Vikhe Patil Foundation's Medical College, Ahilyanagar, Maharashtra
2. Shirsat Shriganesh Shivram
   Department of Microbiology, Dr Vithalrao Vikhe Patil Foundation's Medical College, Ahilyanagar, Maharashtra
3. Satish Ramchandra Patil
   Department of Pharmacology, Krishna Institute of Medical Sciences, Karad, Maharashtra
4. Soumya Ponnan
   Department of Community Medicine (Biostatistics), Dr Vithalrao Vikhe Patil Foundation's Medical College, Ahilyanagar, Maharashtra
5. Kiran P Vakade
   Department of Pharmacology, Dr Vithalrao Vikhe Patil Foundation's Medical College, Ahilyanagar, Maharashtra
6. Sujata A Jadhav
   Department of Pharmacology, Krishna Institute of Medical Sciences, Karad, Maharashtra

Abstract

Acute undifferentiated febrile illness (AUFI) is among the most common indications for hospital admission in tropical and subtropical regions. The overlapping clinical presentations of its diverse aetiologies encompassing rickettsial, leptospiral, viral, and bacterial infections   frequently necessitate empirical antibiotic therapy pending a definitive diagnosis.  Drug utilization studies provide a systematic framework for evaluating prescribing behaviour, identifying deviations from rational pharmacotherapy, and benchmarking adherence to antimicrobial stewardship principles. This was an observational analytical study conducted in 658 patients admitted with AUFI to a tertiary care teaching hospital. Patients were stratified by duration of hospital stay: Group A (≤ 7 days; n = 389) and Group B (> 7 days; n = 269). Categorical variables were compared using the chi-square test and continuous variables using the independent-samples t-test. A p-value of ≤ 0.05 was considered statistically significant. All 658 patients received antibiotic therapy. Intravenous antibiotic use, oral switch, and therapy modification were significantly more frequent in Group B (p < 0.001). Ceftriaxone was the predominant intravenous antibiotic (45.3%), used in all Group B patients. Doxycycline (76.1%) and azithromycin (29.3%) were more commonly administered in Group A, while piperacillin–tazobactam (19.7%) and cefixime as step-down therapy (21.9%) predominated in Group B. Supportive medication use, polypharmacy (mean 6.9 ± 0.97 drugs/patient), and mean antibiotic duration (8.0 ± 1.28 days) were all significantly higher in Group B. Overall, 97.7% of patients were discharged improved; all referrals (2.3%) occurred exclusively in Group B. Antibiotic prescribing in AUFI is predominantly empirical and escalates dynamically with disease severity and duration of hospitalisation. Rational prescribing, enhanced microbiological diagnostics, and structured antimicrobial stewardship programmes are essential to optimise clinical outcomes and curtail the emergence of antimicrobial resistance in this patient population.

Keywords

Acute undifferentiated febrile illness; Drug utilization study; Antibiotic prescribing pattern; Antimicrobial stewardship; Polypharmacy; Empirical therapy

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