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There are certain researches that have been made about
pattern of antibiotics usage in a hospital by professional individuals or
authorised organizations and government. As eloquently stated by one of the
prospective survey done in six Ministry of Health general hospitals in Malaysia
in 1990, study on “Pattern of Antibiotic Usage in Hospitals in Malaysia”, a
prospective, descriptive and cross-sectional survey of antibiotic prescriptions
discharged for inpatients at six public government-run hospitals located across
the country, an overall of 1,918 antibiotics prescription were obtained and
analysed for pattern and trend of usage. The hospitals of which the survey had
taken place have a vast number of beds available for inpatient patients ranging
in size from 800 to 1,000 beds (Lim, Cheong, & Suleiman, 1993).

Sample unit for this prospective study was an antibiotic
prescription whether the prescriptions was discharged for single agent alone or
a combination of multiple antibiotics. Target size of 350 prescriptions for
each hospital was fixed and prescription collection was to gather from several
departments as such; medicine (100), surgical department (100), obstetrics and
gynaecology (50), paediatrics (75) and intensive care unit (25). Each
department was demanded to organise data collection for every successive
antibiotic prescriptions from a selected date until the target number of
prescriptions was collected.  It was
discovered that about two-thirds of 1,918 antibiotics prescriptions were
intended for therapeutic purposes while 20% of stated therapeutic prescriptions
were based on microbiological test results. A total of 661 (36%) prescriptions
came directly from medical departments while 669 (35%) came from surgical
department (which include general surgery, orthopaedics, otorhinolaryngology
and ophthalmology), 344 (18%) were discovered from paediatrics clinics and 214 (11%
from obstetrics and gynaecology (Lim et al., 1993).

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A certain number of 34 different antibiotics per se or
in 136 various combinations were prescribed. These comprised of 7 group
penicillin, 5 group cephalosporin, and 4 group aminoglycosides and 2 group
tetracycline. Out of these, they were about 1063 (55%) single antibiotic
prescriptions and 855 (45%) prescriptions of different combination antibiotics.
In 705 (37%) of those, the prescriptions included two group of antibiotics; in
132 (7%), while precisely three antibiotics were prescribed and in 18 were more
than 3 antibiotics. Of all 34 antibiotics, ampicillin was the most frequent
antibiotic given to patient, being prescribed for as much as 798 (42%)
prescription. The intention of prescribing
antibiotics for therapeutic purpose was in 1263 (66%) prescriptions and 614
(32%) prescription for prophylactic purpose. Prophylactic antibiotics
prescriptions were regularly discovered in surgical and obstetrics and
gynaecology departments (Lim et
al., 1993).

Additionally, as mentioned before,
there were only 255 (20%) of the 1263 therapeutic prescriptions which were
based on microbiological test results. The microbiological tests which were performed
include cultures in 240 instances and serological­­ test in 9 prescriptions. Only 743 (59%) prescriptions involved taking culture prior
to treatment. About 131 (13%) of the 1008 prescriptions, the prescribers were
incapable to identified the specific infection-induced pathogen. Furthermore,
about 614 (32%) prescriptions were intended for antibiotic prophylaxis. Prophylactic
antibiotics prescriptions were regularly found from surgical and obstetrics and
gynaecology departments. Correspondingly, prescriptions for antibiotics
prophylaxis were more often involved combinations of antibiotics. However,
there was certain number of prescriptions which was about 41 which their
purpose was not specified.  In
conclusion, antibiotics and antibiotics regiments employed in the study have
shown a great variability in general. The study identified several evidences of
lack of compliance with guidelines on antibiotic use implemented by the
Ministry of Health in Malaysia (Lim et al., 1993).

There is also a study done in
Lebanon which relates to pattern of antibiotic usage, study on “Community Usage Pattern of Antibiotics within Lebanese Population: A Prospective
Study” by Malak
Khalifeh¹’², Nicholas Moore¹, and Pascale Salam²­ in Lebanon (¹University de
Bordeaux, Bordeaux, France. , ²Clinical & Epidemiological Research
Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon). This
study seeks to discover the usage pattern of antibiotics in Lebanon. The
prospective study was established in a community-based pharmacy setting in
Lebanon, using an organised random interview for patients that came to
community in search of antibiotics. Standard characteristics and reasoning for
taking self-medication were obtained while the usage pattern for the research
was described using Anatomical Therapeutic Chemical Classification/Defined
Daily Doses (ATC/DDD) system (Khalifeh, Moore, and Salameh, 2017).

The total participants in this study was
about 501, with the female being a majority as much as 69.5% of the total.
Among these participants, 314 (62.7%) demanded antibiotics without
prescriptions for their treatment while 187 (37.3) had a prescription for the
antibiotics. The most consumed antibiotic was Amoxicillin-clavunic acid
(coamoxiclav) (33.7%) as cephalosporin (21.2%) followed behind. Besides that,
the most common dispensed antibiotic without prescription was also coamoxiclav
(37.3%) while followed by cephalosporin (21%), penicillin (17.2%), macrolides (6.1%)
and fluoroquinolones (3.8%) correspondingly. On the other hand, the antibiotics
allotted with prescription were as the following ascending order: penicillin
(5.3%), macrolides (14.4%), fluoroquinolones (17.6%), cephalosporin (21.4%) and
coamoxiclav (27.8%). On a side note, 170 (33.9%) participants disclosed they
used antibiotics once annually. The mean for dispensation of antibiotics was
9.07 DDD for short term use which is less than fortnight (

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