J. Pharm. Pharmacogn. Res., vol. 13, no. 5, pp. 1474-1484, Sep-Oct 2025.

DOI: https://doi.org/10.56499/jppres24.2297_13.5.1474

Original Article

Evaluation of antimicrobial prescribing in a second level Mexican hospital

[Evaluación de la prescripción de antimicrobianos en un hospital mexicano de segundo nivel]

Damianys Almenares López¹, Gabriela Alamilla López¹, Sara Hernández Castellano¹, Ivette Reyes Hernández², Edelia C. Villarreal Ibarra¹, Isis B. Bermúdez Camps^2*

¹Popular University of the Chontalpa. Tabasco. México.

²Área Académica de Farmacia. Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo. Pachuca de Soto. Hidalgo. México.

*E-mail: isis_bermudes@uaeh.edu.mx

Abstract

Context: The inappropriate use of antimicrobials is considered a public health problem and represents a health risk for people due to the increase in bacterial resistance, which in turn increases costs and mortality due to infectious diseases.

Aims: To evaluate the prescription of antimicrobials in a second-level hospital in Mexico employing a prescription indication study.

Methods: This analytical, cross-sectional study included 151 hospitalized patients during the first four months of 2023 using an indication-based prescribing assessment framework with elements of a therapeutic scheme. Antimicrobial prescriptions were evaluated using four indicators: indication, therapeutic scheme, individualized treatment, and drug combinations.

Results: A total of 247 antimicrobials were prescribed. The most frequently used agents were ceftriaxone (74%). Inappropriate prescribing was identified in 82% of patients. The most common issues included incorrect indication (58%), improper dosage (22%), frequency of administration errors (22%), and the use of drug combinations with potential moderate-risk interactions (11.5%). Only 42% of prescriptions adhered to clinical practice guidelines regarding antimicrobial selection.

Conclusions: The high rate of inappropriate prescriptions (82%), mainly due to incorrect indications and dosing errors, reveals significant gaps in antimicrobial stewardship at the hospital. The predominant use of ceftriaxone and limited adherence to guidelines underscore the need for urgent interventions. These findings highlight the risk of increasing antimicrobial resistance and emphasize the importance of implementing targeted strategies such as prescriber education, standardized treatment protocols, and regular prescription audits to ensure rational antimicrobial use and improve patient safety.

Keywords: antimicrobial; drug prescribing; drug utilization; indication-prescribing; irrational use of drugs.

Resumen

Contexto: El uso inadecuado de antimicrobianos se considera un problema de salud pública y representa un riesgo para la salud de las personas debido al aumento de la resistencia bacteriana, lo que a su vez incrementa los costos y la mortalidad por enfermedades infecciosas.

Objetivos: Evaluar la prescripción de antimicrobianos en un hospital de segundo nivel en México mediante un estudio de indicación de prescripción.

Métodos: Este estudio analítico y transversal incluyó a 151 pacientes hospitalizados durante el primer cuatrimestre de 2023, utilizando un marco de evaluación de la prescripción basada en la indicación con elementos del esquema terapéutico. Las prescripciones de antimicrobianos se evaluaron mediante cuatro indicadores: indicación, esquema terapéutico, individualización del tratamiento y combinaciones de fármacos.

Resultados: Se prescribieron 247 antimicrobianos. El agente más utilizado fue ceftriaxona (74%). Se identificó prescripción inadecuada en el 82% de los pacientes. Los problemas más comunes incluyeron indicación incorrecta (58%), dosis incorrecta (22%), frecuencia de errores de administración (22%) y el uso de combinaciones de fármacos con posibles interacciones de riesgo moderado (11.5%). Solo el 42% de las prescripciones se ajustaron a las guías de práctica clínica sobre la selección de antimicrobianos.

Conclusiones: La alta tasa de prescripciones inapropiadas (82%), principalmente debido a indicaciones incorrectas y errores de dosificación, revela deficiencias significativas en la optimización del uso de antimicrobianos en el hospital. El uso predominante de ceftriaxona y la escasa adherencia a las guías subrayan la necesidad de intervenciones urgentes. Estos hallazgos resaltan el riesgo de aumento de la resistencia a los antimicrobianos y enfatizan la importancia de implementar estrategias específicas, como la educación de los prescriptores, protocolos de tratamiento estandarizados y auditorías periódicas de las prescripciones, para garantizar el uso racional de los antimicrobianos y mejorar la seguridad del paciente.

Palabras Clave: antimicrobianos; prescripción de medicamentos; prescripción por indicación; uso irracional de medicamentos; utilización de medicamentos.

 

https://jppres.com/jppres/pdf/vol13/jppres24.2297_13.5.1474.pdf

 

 

Citation Format: Almenares López D, Alamilla López G, Hernández Castellano S, Reyes Hernández I, Villarreal Ibarra EC, Bermúdez Camps IB (2025) Evaluation of antimicrobial prescribing in a second level Mexican hospital. J Pharm Pharmacogn Res 13(5): 1474–1484. https://doi.org/10.56499/jppres24.2297_13.5.1474

References

Amariles P, Giraldo NA, Faus MJ (2007) Clinical relevance of drug interactions. Med Clin 129(1): 27–35. https://doi.org/10.1157/13106681

Anpalagan K, Dotel R, MacFadden DR, Smith S, Voss L, Petersiel Neta, Marks Michael, Marsh Julie, Mahar RK, McGlothlin A, Lee TC, Goodman A, Morpeth S, Davis JS, Tong SYC, Bowen AC, the Adjunctive Clindamycin Domain-Specific Working Group for the Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Group (2024) Does adjunctive clindamycin have a role in Staphylococcus aureus bacteremia? A protocol for the adjunctive treatment domain of the Staphylococcus aureus Network Adaptive Platform (SNAP) randomized controlled trial. Clin Infect Dis 79(3): 626–634. https://doi.org/10.1093/cid/ciae289

Arteaga-Livias K, Panduro V, Maguiña JL, Osada J, Rabaan AA, Lijarza, K, Barboza JJ, Gomez W, Rodriguez AJ (2023) Compliance with antibiotic prophylaxis in obstetric and gynecological surgeries in two Peruvian hospitals. Antibiotics 12(5): 808. https://doi.org/10.3390/antibiotics12050808

Bocanegra-Ibarias P, Garza E, Morfín R, Barrios H, Villarreal L, Rodríguez E, Garza U, Petersen S, Silva J (2017) Molecular and microbiological report of a hospital outbreak of NDM-1-carrying Enterobacteriaceae in Mexico. PLoS One 12(6): e0179651. https://doi.org/10.1371/journal.pone.0179651

Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 70(3): 195–283. https://doi.org/10.2146/ajhp120568

CDC (2019) Antibiotic Resistance Threats in the United States 2019 Atlanta, GA: U.S. Department of Health and Human Services, CDC. The full 2019 AR Threats Report, including methods and appendices. http://dx.doi.org/10.15620/cdc:82532

Cokol M, Cetiner S, Erdem N, Bakan F, Cokol M (2020) Guided screen for synergistic three-drug combinations. PLoS One 15(7): e0235929. https://doi.org/10.1371/journal.pone.0235929

Daskalakis K, Juhlin L, Påhlman (2014) The use of pre- or postoperative antibiotics in surgery for appendicitis: A systematic review. Scand J Surg 103(1): 14–20. https://doi.org/10.1177/1457496913497433

Denny KJ, Gartside JG, Alcorn K, Cross JW, Maloney S, Keijzers G (2019) Appropriateness of antibiotic prescribing in the Emergency Department. J Antimicrob Chemother 74(2): 515–520. https://doi.org/10.1093/jac/dky447

Destache CJ (2014) Aminoglycoside-induced nephrotoxicity--a focus on monitoring: a review of literature. J Pharm Practice 27(6): 562–566. https://doi.org/10.1177/0897190014546102

Enzler MJ, Berbari E, Osmon DR (2011) Antimicrobial prophylaxis in adults. Mayo Clin Proc 86(7): 686–701. https://doi.org/10.4065/mcp.2011.0012

EPHMRA (2021) European Pharmaceutical Market Research Association. Anatomical Classification Guidelines 2021. V2021EPHMRA.

Espíritu P, Viso F, Castro LI Pérez L (2007) Beta-lactamic antibiotics utilization study in a Mexican pediatric hospital. Pharm Care España 9(4): 154-168.

Gilbert D, Chambers H, Eliopoulos G, Saag M, Pavia A, Boucher HW (2021) Sanford Guide to Antimicrobial Therapy. Compiled by Cevallos González JL. 52^nd ed. Buenos Aires: Editorial Corpus. https://academianacionaldemedicina.org/publicaciones/libros/guia-sanford-de-terapeutica-antimicrobiana-2021/ [Consulted 15 May, 2024].

Herrera L, Lomas JM, López LE, Luque R, López LF, Martínez FJ, de la Torre J, Plata A, Hidalgo C, García MV, Vinuesa D, Gutiérrez A, Gil MV, De Alarcón A (2022) Ampicillin plus ceftriaxone combined therapy for Enterococcus faecalis infective endocarditis in OPAT. J Clin Med 11(1): 7. https://doi.org/10.3390/jcm11010007

Huynh DTM, Luong CL, Vo QLD, Tran BK, Tran VD (2023) Assessment of the results of clinical pharmacists’ interventions on the use of antibiotics at a medical center in Vietnam between 2021 and 2022. J Pharm Pharmacogn Res 11(5): 787–796. https://doi.org/10.56499/jppres23.1663_11.5.787

IMSS (2017) Prevención, diagnóstico y tratamiento de neumonía adquirida en la comunidad. Guía de Evidencias y Recomendaciones: Guía de Práctica Clínica. México, Instituto Mexicano del Seguro Social; 2017. http://www.imss.gob.mx/profesionales-salud/gpc [Consulted 15 December, 2024].

Lepe JA, Rodríguez-Villodres A, Martín-Gutiérrez G, Luque R, Aznar J (2019) In vitro study of synergy of ampicillin with ceftriaxone against Listeria monocytogenes. Rev Esp Quimioter 32(5): 465–468. https://pmc.ncbi.nlm.nih.gov/articles/PMC6790883/

Milani RV, Wilt JK, Entwisle J, Hand J, Cazabon P, Bohan J G (2019) Reducing inappropriate outpatient antibiotic prescribing: normative comparison using unblinded provider reports. BMJ Open Quality 8(1): e000351. https://doi.org/10.1136/bmjoq-2018-000351

Morales M, Zúñiga CA, Clape O, García E, Quintana T, Dupotey NM, Rodríguez M, Serpa L (2022) Consumption of antibacterials in three hospitals in Santiago de Cuba in the period 2019-2020. J Pharm Pharmacogn Res 10(6): 986–994. https://doi.org/10.56499/jppres22.1453_10.6.986

Najjar PA, Smink DS (2015) Prophylactic antibiotics and prevention of surgical site infections. Surg Clin North Am 95(2): 269–283. https://doi.org/10.1016/j.suc.2014.11.006

Oltra F, Núñez M, Portillo MDM, Navarro C, Rodríguez J, Retamar P (2018) Analysis of quality antimicrobial agent use in the emergency department of a tertiary care hospital. Emergencias 30(5): 297–302.

PAHO (2022) Organización Panamericana de la Salud. Recommendations and evidence synthesis: Guidelines on antibiotic prophylaxis and choice of antiseptics for women in instrumental vaginal delivery or cesarean section. Rev Panam Salud Publica 46: 183. https://doi.org/10.26633/RPSP.2022.183

Ponce de León S (2024) Reporte de los Hospitales de la Red del PUCRA: Resistencia Antimicrobiana y Consumo de Antibióticos. Ciudad de México: Universidad Nacional Autónoma de México. Programa Universitario de Investigación en Salud Estado actual de la Resistencia Antimicrobiana en México. http://www.puis.unam.mx/divulgacion/docs/pucra2024.pdf [Consulted 10, December, 2024].

Saleem Z, Hassali MA, Godman B, Versporten A, Hashmi FK, Saeed H, Saleem F, Salman M, Rehman IU, Khan TM (2020) Point prevalence surveys of antimicrobial use: a systematic review and the implications. Expert Rev Anti Infect Ther 18(9): 897–910. https://doi.org/10.1080/14787210.2020.1767593

Saum LM, Balmat RP (2016) Ceftriaxone potentiates warfarin activity greater than other antibiotics in the treatment of urinary tract infections. J Pharm Pract 29(2): 121–124. https://doi.org/10.1177/0897190014544798

Srinivasan A (2017) Antibiotic stewardship: Why we must, how we can. Cleve Clin J Med 84(9): 673–679. http://doi.org/10.3949/ccjm.84gr.17003

Sood G, Argani C, Ghanem KG, Perl TM, Sheffield JS (2018) Infections complicating cesarean delivery. Curr Opin Infect Dis 31(4): 368–376. http://doi.org/10.1097/QCO.0000000000000472

Tängdén T, Hickman RA, Forsberg P, Lagerbäck P, Giske CG, Cars O (2014) Evaluation of double- and triple-antibiotic combinations for VIM- and NDM-producing Klebsiella pneumoniae by in vitro time-kill experiments. Antimicrob Agents Chemother 58(3): 1757-1762. http://doi.org/10.1128/AAC.00741-13

Venegas GA, Berumen MG, Molina CJ, Jimenez RN, Villanueva EG, Vargas D, Santos G, Velázquez RP, Hernández M, Corral C, Robles N, Lara JM, Sánchez HI (2024) Point prevalence survey of antimicrobial use in second-level Mexican hospitals: a multicenter study. Antibiotics 13(11): 1065. http://doi.org/10.3390/antibiotics13111065

Wong AYS, Root A, Douglas IJ, Chui CSL, Chan EW, Ghebremichael Y, Siu CW, Smeeth L, Wong ICK (2016) Cardiovascular outcomes associated with use of clarithromycin: population based study. BMJ 352: h6926. http://doi.org/10.1136/bmj.h6926

Zavala-González MA, Sánchez-Santana R (2014) Antibiotics prescription quality in pediatric service of General Hospital from Cardenas, Tabasco, Mexico, 2010. Rev Mex Cienc Farm 45(2): 37–42. https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1870-01952014000200005 [Consulted 10 December, 2024].

Zubieta G, González CA, Cartagena EJ, Peña VI, Garzón J, Robledo F (2016) Use of preoperative and postoperative antibiotics in the department of general surgery of a private hospital and a comparison with the current guidelines for antimicrobial management. Acta Med Grupo Ángeles 14(1): 12-18. http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1870-72032016000100012&lng=es&tlng=es [Consulted 4 July, 2022].

Zumaya-Estrada FA, Alpuche CM, Saturno PJ (2021) The WHO methodology for point prevalence surveys on antibiotics use in hospitals should be improved: Lessons from pilot studies in four Mexican hospitals. Int J Infect Dis 108: 13–17. https://doi.org/10.1016/j.ijid.2021.04.079

© 2025 Journal of Pharmacy & Pharmacognosy Research