Study of drug utilization pattern of antimicrobials and adverse drug reactions in pediatric intensive care unit of a tertiary care teaching hospital: An observational, cross-sectional study

Abstract

Drug utilization studies are essential for evaluating rational antimicrobial use in critical care. Pediatric intensive care units (PICUs) are particularly vulnerable to inappropriate prescribing and adverse drug reactions (ADRs), especially in developing countries with limited surveillance data. This study was conducted with the aim to assess antimicrobial utilization patterns and evaluate the incidence, causality, severity, and preventability of antimicrobial-related ADRs in a PICU of a tertiary care teaching hospital. This cross-sectional, observational study was conducted over 18 months (January 2023–June 2024) in a PICU in Central India. A total of 347 children aged 1–12 years were included. Antimicrobial use was evaluated using World Health Organization (WHO) core prescribing indicators and defined daily dose (DDD) per 100 bed days. ADRs were assessed using the WHO-Uppsala Monitoring Centre causality scale, modified Hartwig and Siegel severity scale, and modified Schumock and Thornton preventability scale. The mean age was 6.5 years, with females constituting 54%. The average number of drugs per patient was 7.6; antimicrobials accounted for 38.9% of prescriptions, with a mean of three antimicrobials per patient. Most antimicrobials were administered intravenously (80%), and generic prescribing was low (33.5%). Vancomycin was the most prescribed drug, while gentamicin showed the highest DDD/100 bed days. ADRs were predominantly cutaneous, most probable, mild, and nonpreventable. Extensive antimicrobial use in the PICU underscores the need for strengthened pharmacovigilance and antimicrobial stewardship to promote rational prescribing and enhance pediatric patient safety.