Introduction
Any sickness that is linked with a fever of two weeks or less in length, fast in onset, and brought on by a variety of pathogens is referred to as acute febrile illness or brief febrile illness.1 Fever is one of the most common symptoms that bring patients to the healthcare system where it may or may not occur in association with other common symptoms such as cough or diarrhoea.2, 3 Fever which does not present with pointing features for a particular cause poses a challenge to arrive at a diagnosis as it may be due to various aetiologies like bacterial, fungal, parasitic, and viral. Most of these illnesses have fairly similar clinical symptoms, and specific diagnostic tests are required to arrive at a diagnosis. There are various causes of febrile illness that are acute in tropical nations like Dengue, Malarial fever, Typhoid fever, urinary tract infections, hepatitis, rickettsial infections, leptospirosis, chikungunya, and Meningitis.1
In the paediatric population, respiratory tract infections and stomach illnesses are common. For children under the age of five, lower respiratory tract infections (LRTI) are the main cause of death. Children frequently suffer from viral fever, respiratory infections, and Gastrointestinal infections, which make up the majority of paediatric visits. According to several studies, both in wealthy and developing nations, 50% to 85% of youngsters receive antibiotics. In this population, it is important to take into account both the developmental stage of the kid and the etiopathogenesis of the medical conditions.4
Due to a lack of laboratory confirmation especially in rural areas acute febrile illness aetiologies are underreported in India. Region-specific diagnosis, treatment, and control strategies must be founded on a rigorous examination of the causes of human febrile disease. It is essential to understand the local prevalence of infections for clinical workup and treatment.5 When it comes to identifying bacterial and viral infections and instructing medical professionals on how to administer antibiotics appropriately in patients with respiratory tract infections in high-income countries, biomarkers like C-reactive protein (CRP) and procalcitonin can be useful.6
In the case of people with acute febrile illness (AFI) sometimes try self-treatment before seeking professional medical attention. Local drug dealers who supply antibiotics without a doctor's prescription frequently promote self-treatment techniques, including the usage of antibiotics. Antibiotic resistance is a major global problem. Frequent and without consult consumption of antibiotics are responsible for the emergence and spread of antibiotic resistance. Higher consumption is not only associated with antibiotic resistance at the individual level but also at the community, national and regional levels, with broad implications.7
Antimicrobial resistance (AMR) is linked to antibiotic use. According to a comprehensive analysis, the risk of isolating bacteria that are resistant to antibiotics increases with the amount or length of antibiotics that were provided in the previous 12 months. So it's crucial to use antibiotics wisely in both humans and animals.8 There aren't many studies that emphasize the value of treating these individuals in the emergency room according to a standardized methodology. The burden on the healthcare system grows as a result of the indiscriminate and inappropriate use of antibiotics, which also contributes to the emergence of drug resistance, drug interactions, and severe drug responses.9, 10 There hasn’t been much research in this area up to this point. As a result, this study is being conducted to examine current patterns in the use of antibiotics in patients with febrile illnesses.
Materials and Methods
Study design and site
It is an observational research based on records. The study was conducted for six months at a tertiary care facility in central India. The clearance from the institutional ethics committee mandated the start of the study.
Sample size
We have analysed case record files of patients admitted to the department of Medicine diagnosed as having an acute febrile illness because of different etiologies. A sample size of 300 was selected for the study. The patient’s demographic information, provisional and final diagnoses, and the antibiotics they received for a variety of acute febrile illnesses, including respiratory tract infections, urinary tract infections, acute gastrointestinal infections, malarial infections, urinary tract infections, septicaemia, meningitis, and pyrexia of unknown origin, were recorded using data extraction forms. The data was gathered, and proportion was examined.
Results
All 300 patients who presented with febrile illness were analysed for the prescription of antibacterial agents (AMA). Respiratory tract infections, upper respiratory tract infection (26.6%) and lower respiratory tract infection (9.6%), acute gastroenteritis (16%), and urinary tract infection (12.3%), dengue fever (9%) & viral fever (8.3%), are the most frequent clinical conditions for which antibiotics were prescribed, followed by others as shown in Table 1.
Table 1
Prescriptions for antimicrobials of various etiologies.
Ceftriaxone was one of the most frequently prescribed antibiotics in (20%) and Piperacillin+ Tazobactum (16.25%) followed by Amoxycillin + clavulanic acid (10.5%), Clarithromycin (8.5%), Cefuroxime (7.25%), followed by others as shown in Table 2.
Table 2
Commonly prescribed antimicrobial agents (AMA).
Discussion
Antimicrobial medications (AMA) were prescribed to 300 individuals for febrile illnesses with a variety of etiologies. In our analysis, respiratory tract infections (upper respiratory tract infection, 26.6%, and lower respiratory tract infection, 9.6%), acute gastroenteritis (16%), and urinary tract infection (12%%) were the most frequent etiologies for which antibiotics were recommended. (12.3%) followed by dengue fever (9%), viral fever (8.3%) and others. These infectious conditions are commonly seen in developing countries. The antibiotic trend that is seen in our study is ceftriaxone in (20%) and Piperacillin and Tazobactum (16.25%) followed by Amoxycillin + clavulanic acid (10.5%), Clarithromycin (8.5%), Cefuroxime (7.25%), followed by others. Rangdal et al in their study found respiratory tract infection (36%) followed by GIT disorders (24%), zoonotic disease (10%), urinary tract infection (19%), and viral fever (11%), as the most frequent causes of febrile illness. The antibiotic pattern observed in their study was ceftriaxone (40%) in the most number of patients, followed by piperacillin (26%). 11 Meher et al in their study found that the most frequent clinical disorders for which antibiotics are prescribed are gastroenteritis (18%), urinary tract infection (18%), respiratory tract infection (24%), Septicemia (13%), typhoid fever (16%), Meningitis (8%), unknown pyrexia (3%), while ceftriaxone (30.03%) was the most frequently given antibiotic, followed by co-amoxiclav (22.6%), amikacin (16.33%), ciprofloxacin (13.41%).12 In a study conducted by Ahmed et al respiratory tract infection accounts for the most hospital admissions followed by viral illness (12%), urinary tract infection (8.5%), and acute gastroenteritis (7.5%). In monotherapy prescriptions, ceftriaxone was most commonly prescribed and in polytherapy prescriptions, Amoxicillin with clavulanic acid and amikacin were most frequently prescribed together. 13 In research by Kaur et al, prescriptions for 29 different antibiotics were made for a variety of etiologies, with 12 medicines accounting for more than 80% of those prescriptions. The two most commonly utilized medications were ceftriaxone (19.2%) and amoxicillin-clavulanic acid (16.9%). followed in 41 (11.4%) patients with piperacillin-tazobactam. 14 The majority of conditions for which antibiotics were recommended in retrospective research conducted in the general medicine department included COPD, pneumonia, LRTI, UTI, PUD, URTI, viral fever, tuberculosis, acute bacterial dysentery, GERD, rheumatoid arthritis, and surgery. The majority of them took antibiotics from the cephalosporin class, which were then followed by penicillin, fluoroquinolones, and aminoglycosides. 15 These findings are in accordance with our study.
In a research project by Kapure et al. The majority of patients (71.42%) received cephalosporin prescriptions, which were then followed by quinolone (39.68%), aminoglycoside (28.57%), antiamoebic (24%), penicillins (19.04%), etc. Cefuroxime was the most commonly used cephalosporin (33.33%), followed by cefotaxime (25.39%), ceftriaxone (6.32%), and Cefoperazone. 16 Khan et al in their study β-lactams were mostly prescribed of which amoxicillin with clavulanic acid is the most commonly prescribed followed by ceftriaxone, levofloxacin, nitroimidazoles, aminoglycosides and the macrolides. 17 These findings are inconsistent with our study in which ceftriaxone was the most commonly used drug. To increase the rational use of antimicrobials and to solve the resistance issue, antimicrobial protocol and recommendations as well as formulary-based antimicrobial usage might be employed. For the best antimicrobial medication, a multidisciplinary strategy can be used in the ICU and IPD setting, involving specialists in intensive care, infectious disease control, pharmacy, and microbiology. 16
Conclusion
Febrile illness can have various etiologies. Our study concludes that respiratory tract infections, gastrointestinal infections, and urinary tract infections were the three conditions for which antibiotics were most frequently recommended. Ceftriaxone, Piperacillin-Tazobactum and Coamoxyclav were the most commonly given antimicrobials. As a component of the medical audit, the study of prescribing patterns aims to monitor, assess, and, if necessary, advise modification in prescribing practices to make medical care reasonable and cost-effective.
