Irrational Use of Antibiotics in Iraqi Public Hospitals

. Antibiotic resistance is a major challenge world-wide. If antibiotics are overused or used in- correctly, there is a greater chance of inducing resistance in bacteria. Therefore, it is very essential to use antibiotics rationally. The study objective was to describe the current prescribing patterns and antibi- otics used in public hospitals using a sample from Baghdad hospitals. The study was a retrospective ob- servational study. The study data were collected from the medical records of 100 patients, from three public hospitals in Baghdad: Baghdad Teaching Hospital, Al-Yarmouk Teaching Hospital, and Ghazi Al- Hariri Teaching Hospital. Collected information included the demographic information (age, gender, weight, length of hospital stays), received antibiotics, antibiotic dose, culture and sensitivity test, labora- tory tests, diagnosis, and present illness. The data collection occurred between February 1, 2022 and March 302022. The study included 100 patients who received antibiotics in the three hospitals. The ma- jority of patients (62%) were male. The average of age of patients was 52.3 & PLUSMN;19.5 years with average hos- pitalization stay of 12.3 & PLUSMN;6.4 days. The average hospitalization stay for those inpatients was 12.3 & PLUSMN;6.4 days. The majority of cases (54%) were obtained from Baghdad Teaching Hospital. Almost all the pre- scribed antibiotics in the recorded records from the participating three public hospitals relied mainly on empirical practice (97%) and only 3% of cases relied on the results of the culture and sensitivity (C/S) test. The culture and sensitivity tests showed growth of staphylococcus species (coagulase negative) which was resistance to most of the tested antibiotics: Levofloxacin, azithromycin, trimethoprim, doxycycline, and tetracycline. The available C/S test did not cover all common antibiotics including Meropenem and cephalosporin. However, Meropenem was prescribed in combination with Vancomycin or ceftazidime/ ceftriaxone for two of the patients having C/S test since the bacteria was resistance to other available in- jectable antibiotics such as Fluoroquinolones. Ceftriaxone (71%) and metronidazole (41%) were the most commonly used antibiotics empirically. In contrast, gentamycin (1%) and ceftazidime (4%) were the least antibiotic used for those admitted patients. According to the related laboratory tests, 40% of pa- tients had elevated white blood cells which indicates infection. Shortness of breath (54%) and chest pain (48%) were the most frequent reported chief complaints for the admitted patients taking antibiotics. In most circumstances, hospital physicians prescribed antibiotics empirically without requesting culture and sensitivity tests. Complete blood picture showed that less than half of patients who received antibi- otics had elevated white blood cells. These results indicates that the prescribing practice is not relying on evidence-based results. This may lead to emerging multi-antibiotic resistance bacteria. Implementation of a strict antibiotic stewardship program in public hospitals is essential to use antibiotics appropriately and improve patient clinical outcome.