Surveillance of antimicrobial utilization among outpatient settings of a tertiary care hospital.

BACKGROUND: Antimicrobial stewardship programs typically focus on inhospital settings, with limited information available on the quality of antimicrobial use in hospital outpatient clinics. Given the significant volume of antibiotic consumption in outpatient settings, effective surveillance and identification of target areas should be prioritized as a strategic plan to optimize antimicrobial use. METHODOLOGY: Prescriptions of the patients attending outpatient clinics of a tertiary care hospital containing at least one systemic antimicrobial agent (AMA) were screened. Patients' clinical and demographic data were entered into the case record form. Appropriateness of antimicrobial prescribing was defined as being in accordance with the ICMR standard treatment guidelines. Logistic regression analysis was used to assess the association between various independent variables with the appropriateness of prescribing. RESULTS: 35.34% (422/1194) of the outpatient prescriptions contained at least one AMA. Moreover, 36.96% (156/422) of the prescriptions containing antimicrobials deviated from the standard treatment guideline. Prescriptions for upper respiratory tract infections (URTIs) (115/156) (P < 0.0001) and prescriptions written by intern doctors (P < 0.0001) were significantly associated with inappropriate prescribing. Overall amoxicillin-clavulinic acid was the most commonly prescribed AMA in the outpatient setting and azithromycin was the most inappropriately prescribed AMA. CONCLUSION: Outpatient settings are a crucial component for the implementation of antibiotic stewardship strategies. Prescriptions for URTIs and those prescribed by intern doctors could be identified as high-priority conditions for intervention.