Assessment of Antibiotic Utilization Pateern, Comparision With Guidelines and Infection Diagnosis Strategies at the Clinic of Mizan Prison, Bench Sheko Zone, South-west Ethiopia Retrospective Cross Sectional Study

Assessment of Antibiotic Utilization Pateern, Comparision With Guidelines and Infection Diagnosis Strategies at the Clinic of Mizan Prison, Bench Sheko Zone, South-west Ethiopia Retrospective Cross Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Antibiotic Utilization Pateern, Comparision With Guidelines and Infection Diagnosis Strategies at the Clinic of Mizan Prison, Bench Sheko Zone, South-west Ethiopia Retrospective Cross Sectional Study MEKURIAW DEREJE TEKELE This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3936906/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Antibiotics are strong and effective medicines which are used to treat most different bacterial infections. Antibiotics prescribing should be appropriate and restricted since inappropriate use may contribute to the emergence of resistant microorganisms may lead to unnecessary adverse drug events and has been associated with increased health care costs. Objective: The aim of this study was to assess antibiotic utilization pattern in clinic of Mizan prison. from August 1-October 30, 2023. Methods: Retrospective cross sectional study was conducted in clinic of Mizan prison to assess antibiotic utilization pattern from August 1-October 30, 2023.The data was analyzed by using Statistical Package for Social Sciences (SPSS) Version 21.0 Result: This study was intended to assess antimicrobial utilization pattern, a total of 187 medical records containing antimicrobial agents were evaluated and analyzed at clinic of Mizan prison. From a total patients, number of male patients 127(67.9%) and females 60(32%).Most of the patients were from 19-35 age and the least number of patients belonged to age group of ≥69. Conclusion :This study gives an overview of antibiotic utilization in clinic of Mizan prison. amoxaicilin, metronidazole, ciprofloxacin were the most frequently prescribed individual drugs.Ineffective drug therapy, need additional drug therapy, unnecessary drug therapy most encountered drug therapy problem followed by dose too high, dose too low, adverse drug reaction and patient compliance. Antibiotic Utilization Clinic Prison Pattern Figures Figure 1 Figure 2 Figure 3 Introduction Antibiotics are powerful medicines that fight bacterial infections. If used properly, antibiotics can save lives. They either kill bacteria or keep them from reproducing. Your body's natural defenses can usually take it from there [ 1 ]. Antibiotic misuse or over-use may increase the emergence of resistant bacteria and as a result increase the selection pressure on physicians who tend to prescribe newer broad spectrum agents for excessive periods of time Antibiotic resistance has become a serious problem in both developed and developing nations [ 1 , 2 , 5 , 7 , 15 , 23 ]. Rational drug use is the process of appropriate prescribing, dispensing, and patient use of drugs for diagnosis, prevention and treatment of diseases. It encompasses rational prescribing, rational dispensing and rational patient use. The advantage of rational drug use is to foster better quality of pharmaceutical care, to minimize the cost of drug therapy, to avoid preventable adverse drug reactions and drug interactions, to maximize therapeutic outcomes and to promote patient adherence [ 3 ]. Several strategies for controlling antibiotic usage have been proposed. Such as formulary replacement or restriction, introduction order form, health care provider education, feedback activates, and approval requirement from infectious disease specialist for drug prescription [ 4 , 5 ]. Drug Use Evaluation (DUE) is an ongoing systematic process designed to maintain the appropriate and effective use of drug. It incorporates qualitative measure and emphasizes outcome including pharmaco economics assessment. DUE can identify problem in drug use, reduce adverse drug reaction, optimize drug therapy and minimize drug related expense it often include intervention to ensure appropriate drug use [ 6 ]. DUE focuses on the area that shows greater potential for improvements. It involve on compressive review of patient prescription and medication data, during and after dispensing in order to ensure appropriate therapeutic decision making and promote positive outcome [ 7 ]. Methods and Materials Study Area and period: The study was conducted at clinic of Mizan prison which was found in bench Sheko zone, Mizan-Teferi town, south west regional state; which was located 565 km south west of Addis Ababa, the capital city of Ethiopia from August 1-October 30, 2023. Study Design Retrospective cross sectional study was conducted in clinic of Mizan prison to assess antibiotic utilization pattern from August 1-October 30, 2023. Population Source population All the prisoners of Mizan prison. Study population Medical records of patient who treated at clinic of Mizan prison and who take antibiotic in 2023. Inclusion and Exclusion criteria Inclusion criteria All medical records prescribed with antibiotics in clinic of Mizan prison in 2023. Exclusion Criteria Patients who did not have antibiotic prescription for less than 24 hour. Incomplete medical records Sample size determination and Sampling technique Sample size determination The sample size determined using the following formula: n = z 2 P (1 − p)/d 2 . Where: n = sample size p = prevalence of antibiotic utilization among medical ward patients d = margin of sampling error tolerated z = the standard normal value at confidence interval of 95% Study done in 2017 on antibiotic utilization in a specialized teaching hospital in Addis Ababa. Ethiopia. out of 1645 patient included in the study the prevalence of antibiotic utilization was 81.6[ 25 ]. This value was taken to determine sample size The number of patients was 800 per year which was less than10, 000, therefore it Needs to be adjusted using finite population correction formula Adjusted n = n*N/n + N = 230*800/230 + 800 = 178 Where n was calculated sample size and N was the number of patients per year which was 800 To compensate for incomplete prescription and errors 5% of the size will added and a total of 187 patient cards were taken from study population. Sampling Technique Systematic random sampling technique was used to select patient medical records while the first is obtained by lottery method there by every fourth patient medical records were selected from average total medical records of one year. Data collection Data collection instrument and techniques For patients on antibiotic therapy, the provisional clinical diagnosis, any microbiological test results, the antimicrobial agents administered, whether the prescription was based on those results or empirically used and the dosage of the drug administered. The last section of the sheet was allocated to the type of inappropriate antibiotic use if there were any Errors. Data quality control A standardized data abstraction format was prepared in the English language based on previous literature reviews, related studies, and other standard protocols. The abstraction format was per-tested before commencing the actual data collection and then the necessary adjustment was performed. Before data entry and analysis, data were cleared, categorized, compiled, coded, and verified to ensure completeness and accuracy. Data processing, analysis and presentation Data were checked for completeness and consistency and entered into SPSS version 21.0 by principal investigators, cleans, and analyzes. The result was presented using simple frequencies with percentages in appropriate tables to display the descriptive part of the result. Operational definition Antibiotic utilization: is using of the antimicrobial for treatment of bacterial infections. Kinetic treatment:-a kind of treatment that can be done after laboratory identification of the causative agent (antibiotic therapy directed at final organism). Empirical treatment: is an administration of drugs without an identification of causative age. Rational drug use; generally it can cover the appropriate prescribing, appropriate dispensing and appropriate patient use so it is the appropriate indication and use of antibiotics. Results Socio-demographic characteristics This study was intended to assess antimicrobial utilization pattern, a total of 187 medical records containing antimicrobial agents were evaluated and analyzed at clinic of Mizan prison. From a total patient, number 127(67.9%) are Male and most of the patients were from 19-35 year.(table 1) Table 1 Socio-demographic characteristics of patients at clinic of Mizan prison (n=187) Variables Frequency Percentage Sex Male 127 67.9% Female 60 32.1% Age 15-24 46 24.5% 25-34 62 33.1% 35-44 35 18.7% 45-54 28 14.9% 55-64 15 8% Greater than 64 1 0.5% The Most Commonly Prescribed Antibiotic At Clinic Of Mizan Prison Among all patients medical records containing antibiotics commonly used antibiotics includes; Amoxicillin(36.96%) followed by metronidazole(13.04%), ciprofloxacin(8.70%), Tinidazole(8.70%), cloxaciliin(7.61%), B.penicillin(7.07%) Albendazole(6.52%), doxycyclline(6.52%) and gentamicine (4.89%), others.(Figure 1) Common diagnosis at clinic of Mizan prison The most common reasons for which antibiotic prescribed was condition like community acquired pneumonia 60(31.25%), Typhoid 28(14.58%), Giardiasis 20(13.02%), Urinary Tract Infection 25(10.42%), Amobiasis14 (7.29%), Diarrhoea (6.25%), Tonsillitis 5(3.13%) and others 33(14.06%). Diagnosis Strategies At Clinic Of Mizan Prison Out 187 patient 119(63.6%) were treated empirical, where as 24(12.8%) were stool, urine analysis 17( 9%) and other 27(14.4%).(table 2) Table 2 Diagnosis Strategies At Clinic Of Mizan Prison (n=187) Diagnosis Frequency Percentage Empirical 119 63.6% Stool 24 12.8% Urine analysis 17 9% CBC 0 0 Other 27 14.4% Average treatment duration, Reinfection and/or Relapse Status of Patient over the past 28 Days Majority 125(66.8%) of the patient were treated below three to five days and 65(34.8%) were visit the clinic again for the same sign and symptoms over the past 28 days. (table 3) Table 3 Average treatment duration, Reinfection and/or Relapse Status of Patient over the past 28 Days Variable Frequency Percentage Duration of treatment 1-2 days 27 14.4% 3-5 days 125 66.8% > 5 days 35 18.7% total 187 100% Next visit over 28 days Yes 65 34.8% No 122 65.2% total 187 100% Common Route and dosage of Administration Majority of antibiotic Prescribed by Oral route 140(75.3%),Followed by Parental route 13(6.9%).Regarding the dosage form of antibiotic Capsule 92(49.7%),Tablet 48(25.6%)and eye drop 14(7.4%) were the most commonly prescribed dosage form.(figure3) Comparison with Guidelines and Drug therapy problems related with antibiotics 88.7% of the patient were treated irrespective of treatment guideline of Ethiopian standard treatment guideline 2021 (last edition), and need additional drug therapy was the predominant DTP which accounts around 47% of DTP observed followed by patient compliance (22%). (Table 4) Table 4 Comparison with Guidelines and Drug therapy problems related with antibiotics Category frequency Percentage Treatment According To Stg 2021 Yes 21 11.3% No 166 88.7% Total 187 100% Drug Therapy Problem Ineffective Drug 25 12.65% Need Additional Drug 78 46.98% Patient Compliance 37 22.3% Unnecessary Drug 10 6.02% Dose To Low 10 6.02% Dose To High 5 3.01% Adverse Drug Interaction 1 0.6% Total 166 100% Discussion Antibiotics are the key drugs for treatment of infections and are among the most commonly prescribed drugs in Mizan prison clinic. According to this study, the most frequently prescribed individual antimicrobial agents were amoxicillin, metronidazole, ciprofloxacilin, B.penicillin, Tinidazole and doxycycline slight diffrence were observed compared to Study done on antibiotic utilization pattern in a italy prison were the most frequently prescribed antimicrobial was amoxicillin and clavulanic acid, followed by amoxicillin, macrolides and third-generation cephalosporin’s and this variation is possibly justified by being different setting and availability of potential alternative antibiotic in the setting. [ 18 ]. This was different from other study done in Nekemte showed that,. From the total of antibiotics, cotrimoxazole was the most frequently prescribed followed by amoxicillin and also chloramphenicol, gentamicine, cephalexin, and crystalline penicillin. The study done in Nekemte showed that, the total of drugs including antibiotics were prescribed to the total of 341 patients; out of which 373 were antibiotics. From the total of antibiotics, cotrimoxazole was the most frequently prescribed followed by amoxicillin and also chloramphenicol, gentamicine, cephalexin, ceftriaxone, crystalline penicillin. Doxycycline and procaine Penicillin Fortified were prescribed for only two patients each and norfloxacin and azithromycin were prescribed for one patient each. In this study the most commonly prescribed classes of antibiotics includes penicillin followed by sulfonamides, cephalosporin and the least prescribed class was macrolides and tetracycline [ 23 ]. Concerning to the clinical indication, this study showed that the most common reason for which antibiotics prescribed was community acquired pneumonia followed by typhoid, urinary tract infection, Giardiasis, amobiasis, diarrhea, tonsillitis, eye infection and others. Similar study done in Saudi Arabia showed that the most prevalent indications for prescribing were respiratory tract infections. All antibiotics prescribed were broad-spectrum. Antibiotics were prescribed for patients with malaria and also in situations where diagnosis was uncertain [ 20 ].and also similar study in Italy prison showed that, URTI and dental infections. Among the URTI, pharyngitis, acute bronchitis, influenza, common cold, and were rhino-sinusitis, where as among dental infections symptomatic irreversible pulpits with or without symptomatic apical periodontitis, and pulp necrosis and symptomatic apical periodontitis/pulp necrosis and localized acute apical abscess [ 18 ]. Regarding to the route of administration, the majority 140(49.7%) of antimicrobial were prescribed by oral followed by parenteral 13(6.9%), syrup12 (6.4%), and eyedrop14 (7.4%). This was similar with study done in Italy prison the route of administration was oral in 84.8% and intramuscular. In this study, the empirical diagnosis is 129(68.9%) and laboratory diagnosis 58(31%) antimicrobial agents were amoxicillin, doxycycline, ciprofloxacilin, B.penicillin, Tinidazole, albendazole, gentamicine and metronidazole, this is because those drugs can be used in a wide variety of disease conditions in clinic patients, easily availability ,available in different dosage forms, preferred in severe cases due to its fast onset of action. Conclusion This study gives an overview of antibiotic utilization in clinic of Mizan prison.amoxaicilin, metronidazole, ciprofloxacilin were the most frequently prescribed individual drugs. community acquired pneumonia was most prevalent disease followed by, typhoid and typhus, urinary tract infection, was found to be primary case for clinic visit among prisoners. The percentage of oral drugs was very high compared to drugs administered through parenterally. Ineffective drug therapy, need additional drug therapy, unnecessary drug therapy most encountered drug therapy problem followed by dose too high, dose too low, adverse drug reaction and patient compliance Recommendation We would like to recommend… The prescribers and pharmacist in prison clinic should prescribe and dispense antimicrobials according to the STG . The prison should provide enough drugs. The prison should increase human resource for clinic. The pharmacists in prison clinic should encourage the prisoners to take drugs according to correct route, dose and frequency. The pharmacist to counsel the patients accordingly and correctly. Abbreviations AR; antimicrobial resistance, DUE; drug use evaluation, DTC; drug therapeutic commute, DTC; drug therapy problem , EDL;essential drug list, WHO; world health organization, STG; standard treatment guideline Declarations Acknowledgments We would like to acknowledge Mizan prison administrative and health care provider for their cooperation and support during the data collection period . Funding This work was not funded by anyone. Declarations Ethics approval and consent to participate Ethical clearance was obtained from the institutional review board of Mizan Tepi University, college of Medicine and Health. Letter of permission was presented to the managements of Mizan prison who allowed us to use patients’ medical records. Patients’ information such as name and address of the patients was not recorded . This study did not involve human experiments or human tissue . All findings in this paper were performed in accordance with relevant guidelines and regulations (such as the Declaration of Helsinki). Consent for publication Not applicable to this work. Competing interests The authors declared no potential competing of interest concerning the research, authorship, and/or publication of this article. Data availability All the datasets used/or analyzed during the current study are available from the corresponding author upon reasonable request. Conflict of interest All authors declare no conflict of interest. Authors’ Contributions Authors’ Contributions All authors contributed to data analysis, drafting, or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published,and agree to be accountable for all aspects of the work. References CDC Antibiotic use in the United States. Antibiotic use in the United States, 2017. Progress and opportunities. Atlanta US Department of Health and Human Service, CDC;2017. Hulscher ME, Grol RP,van der Merr JW. Antibiotic prescribing in hospitals: a social and behavioural scientific approach. Lancet Infect Dis. 2018;10(3):167–75. Kardas P, Devine S, Golembsky A, Roberts C. A systemic review and meta-analysis of misuse of antibiotic therapies in the community. Int J Antimicrob Agents.2018;26(2):10613. Guglielemo BJ Practical strategies for appropriate use of antimicrobial. Pharm World Sci 2018,17:96–102. Phillips MS, Gayman JE, Todd MW,ASHP guidelines on medication-use evaluation. American society of Health-system Pharmacists. Am J Health Syst Pharm 2017,53: 1953–1955. Wise R, Hart T, Cars O, Strenulens M, Helmuth R, Huovinen P, Sprenger M. Antimicrobial resistance. Is a major threat to public health.BMJ. 2017 Sep5;317(7159):609–10. Dajani R, Hart T,Cars O, Streulens M,Helmuth R, Huovinen P, Sprenger M. Antimicrobial resistance. Is a major threat to public health. WHO. Ten Threats to Global Health in 2019. Available online: https://www.who.int/news-room/spotlight/ten-threats-to global-health-in-2019 (accessed on 13 October 2021). Thapaliya K, Shrestha S, Bhattarai S, Basnet D, Chaudhary RM, 2015, Prescribing Pattern of Antibiotics in Pediatric hospital in chitwan district in Nepal, world journal of pharmacy and pharmaceutical sciences; 4(11): 1631-41 Minyahil A. Woldu, Suleman S, Workneh N, and Berhane H, 2013, Retrospective Study of the Pattern of Antibiotic Use in Hawassa University Referral Hospital Pediatric Ward, Southern Ethiopia,Journal of Applied Pharmaceutical Science; 3 (02):093–098 Nobile, C.G.; Flotta, D.; Nicotera, G.; Pileggi, C.; Angelillo, I.F. Self-reported health status and access to health services in a sample of prisoners in Italy. BMC Public Health 2011, 11 , 529. Massoglia, M.; Pridemore, W.A. Incarceration and Health. annu. Rev. Sociol. 2015, 41 , 291–310. Pereira LP, Phillips M, Ramlal H, Teemul K, Prabhakar P. Third genera– tion cephalosporin use in a tertiary hospital in Port of Spain, Trini– dad: need for an antibiotic policy. BMC Infect Dis. 2018. https://doi.org/10.1186/1471–2334–4 –59. Dajani AS. Adherence to physicians' instructions as a factor in managing streptococcal pharyngitis. Pediatrics. 2016,Jun;97(6 Pt 2):976–80. Pechère JC. Parameters important in short antibiotic courses. J Int Med Res. 2019;28 Suppl 1:3A-12A. Sclar DA, Tartaglione TA, Fine MJ. Overview of issues related to medical compliance with implications for the outpatient management of infectious diseases. Infect Agents Dis. 2019;3(5):266–73. Getachew E, Aragaw S, Adissie W, and Agalu A, 2013, Antibiotic prescribing pattern in a referral hospital in Ethiopia,Global Journal of Pharmacy and Pharmacology;1 (1): 078–082 Di Giuseppe, G.; Lanzano, R.; Silvestro, A.; Napolitano, F.; Pavia, M. Pattern and Appropriateness of Antimicrobial Prescriptions for Upper Respiratory Tract and Dental Infections in Male Prisoners in Italy. Venkateswaramurthy N, Murali R Sampathkumar R, 2012, The study of drug utilization pattern in pediatric patients. International Journal of Pharmacy and Pharmaceutical Sciences; 5(03): 140–44. Alakhali K, Shaik Mohammad A, 2014, Prescribing Pattern of Antibiotics in Pediatric Patients in the Jazan Region, Kingdom of Saudi Arabia, RGUHS J Pharm Sci; 4 (3) Chem ED, AnongDN, Akoachere J-FKT Prescribing patterns and associated factors of antibiotic prescription in primary health care facilities of Kumbo East and Kumbo West Health Districts, North West Cameroon. PLoS ONE2018, 13(3) Oumer Abdu Muhie, Antibiotic Use and Resistance Pattern in Ethiopia: Systematic Review and Meta-Analysis, International Journal of Microbiology 2019,8 Asefa L, Bayissa G, and Abera Z,2016, Antibiotics Use Evaluation for Pediatrics at Nekemte Referral Hospital, East Wollega Zone, Oromia Region, West Ethiopia, World Journal of Medical Sciences; 13 (1):17–26 Federal Bureau of Prisons Antimicrobial Stewardship Guidance Clinical Practice Guidelines March 2013. E.L tover, et al Antibiotic utilization in a specialized teaching hospital in Ethiopia (adiss abeba),clinical therapeutics 2017,39,84 – 65. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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If used properly, antibiotics can save lives. They either kill bacteria or keep them from reproducing. Your body's natural defenses can usually take it from there [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Antibiotic misuse or over-use may increase the emergence of resistant bacteria and as a result increase the selection pressure on physicians who tend to prescribe newer broad spectrum agents for excessive periods of time Antibiotic resistance has become a serious problem in both developed and developing nations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRational drug use is the process of appropriate prescribing, dispensing, and patient use of drugs for diagnosis, prevention and treatment of diseases. It encompasses rational prescribing, rational dispensing and rational patient use. The advantage of rational drug use is to foster better quality of pharmaceutical care, to minimize the cost of drug therapy, to avoid preventable adverse drug reactions and drug interactions, to maximize therapeutic outcomes and to promote patient adherence [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral strategies for controlling antibiotic usage have been proposed. Such as formulary replacement or restriction, introduction order form, health care provider education, feedback activates, and approval requirement from infectious disease specialist for drug prescription [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDrug Use Evaluation (DUE) is an ongoing systematic process designed to maintain the appropriate and effective use of drug. It incorporates qualitative measure and emphasizes outcome including pharmaco economics assessment. DUE can identify problem in drug use, reduce adverse drug reaction, optimize drug therapy and minimize drug related expense it often include intervention to ensure appropriate drug use [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. DUE focuses on the area that shows greater potential for improvements. It involve on compressive review of patient prescription and medication data, during and after dispensing in order to ensure appropriate therapeutic decision making and promote positive outcome [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy Area and period:\u003c/h2\u003e\n \u003cp\u003eThe study was conducted at clinic of Mizan prison which was found in bench Sheko zone, Mizan-Teferi town, south west regional state; which was located 565 km south west of Addis Ababa, the capital city of Ethiopia from August 1-October 30, 2023.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy Design\u003c/h2\u003e\n \u003cp\u003eRetrospective cross sectional study was conducted in clinic of Mizan prison to assess antibiotic utilization pattern from August 1-October 30, 2023.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003ePopulation\u003c/h2\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003eSource population\u003c/h2\u003e\n \u003cp\u003eAll the prisoners of Mizan prison.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy population\u003c/h2\u003e\n \u003cp\u003eMedical records of patient who treated at clinic of Mizan prison and who take antibiotic in 2023.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eInclusion and Exclusion criteria\u003c/h2\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003ch2\u003eInclusion criteria\u003c/h2\u003e\n \u003cp\u003eAll medical records prescribed with antibiotics in clinic of Mizan prison in 2023.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003eExclusion Criteria\u003c/h2\u003e\n \u003cp\u003ePatients who did not have antibiotic prescription for less than 24 hour.\u003c/p\u003e\n \u003cp\u003eIncomplete medical records\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eSample size determination and Sampling technique\u003c/h2\u003e\n \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n \u003ch2\u003eSample size determination\u003c/h2\u003e\n \u003cp\u003eThe sample size determined using the following formula:\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;z\u003csup\u003e2\u003c/sup\u003eP (1\u0026thinsp;\u0026minus;\u0026thinsp;p)/d\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003eWhere: n\u0026thinsp;=\u0026thinsp;sample size\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;=\u0026thinsp;prevalence of antibiotic utilization among medical ward patients\u003c/p\u003e\n \u003cp\u003ed\u0026thinsp;=\u0026thinsp;margin of sampling error tolerated\u003c/p\u003e\n \u003cp\u003ez\u0026thinsp;=\u0026thinsp;the standard normal value at confidence interval of 95%\u003c/p\u003e\n \u003cp\u003eStudy done in 2017 on antibiotic utilization in a specialized teaching hospital in Addis Ababa. Ethiopia. out of 1645 patient included in the study the prevalence of antibiotic utilization was 81.6[\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003eThis value was taken to determine sample size\u003c/p\u003e\n \u003cp\u003e\u003cimg 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\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003cp\u003eThe number of patients was 800 per year which was less than10, 000, therefore it\u003c/p\u003e\n \u003cp\u003eNeeds to be adjusted using finite population correction formula\u003c/p\u003e\n \u003cp\u003eAdjusted n\u0026thinsp;=\u0026thinsp;n*N/n\u0026thinsp;+\u0026thinsp;N\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; =\u0026thinsp;230*800/230\u0026thinsp;+\u0026thinsp;800\u003c/p\u003e\n \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; =\u0026thinsp;178\u003c/p\u003e\n \u003cp\u003eWhere n was calculated sample size and N was the number of patients per year which was 800\u003c/p\u003e\n \u003cp\u003eTo compensate for incomplete prescription and errors 5% of the size will added and a total of 187 patient cards were taken from study population.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eSampling Technique\u003c/h2\u003e\n \u003cp\u003eSystematic random sampling technique was used to select patient medical records while the first is obtained by lottery method there by every fourth patient medical records were selected from average total medical records of one year.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003eData collection\u003c/h2\u003e\n \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\n \u003ch2\u003eData collection instrument and techniques\u003c/h2\u003e\n \u003cp\u003eFor patients on antibiotic therapy, the provisional clinical diagnosis, any microbiological test results, the antimicrobial agents administered, whether the prescription was based on those results or empirically used and the dosage of the drug administered. The last section of the sheet was allocated to the type of inappropriate antibiotic use if there were any Errors.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eData quality control\u003c/h2\u003e\n \u003cp\u003eA standardized data abstraction format was prepared in the English language based on previous literature reviews, related studies, and other standard protocols. The abstraction format was per-tested before commencing the actual data collection and then the necessary adjustment was performed. Before data entry and analysis, data were cleared, categorized, compiled, coded, and verified to ensure completeness and accuracy.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003eData processing, analysis and presentation\u003c/h2\u003e\n \u003cp\u003eData were checked for completeness and consistency and entered into SPSS version 21.0 by principal investigators, cleans, and analyzes. The result was presented using simple frequencies with percentages in appropriate tables to display the descriptive part of the result.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003ch2\u003eOperational definition\u003c/h2\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eAntibiotic utilization: is using of the antimicrobial for treatment of bacterial infections.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eKinetic treatment:-a kind of treatment that can be done after laboratory identification of the causative agent (antibiotic therapy directed at final organism).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eEmpirical treatment: is an administration of drugs without an identification of causative age.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eRational drug use; generally it can cover the appropriate prescribing, appropriate dispensing and appropriate patient use so it is the appropriate indication and use of antibiotics.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n\u003c/div\u003e\n"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was intended to assess\u0026nbsp;antimicrobial utilization pattern, a total of 187 medical records containing antimicrobial agents were evaluated and analyzed at clinic of Mizan prison. From a total patient, number 127(67.9%) are Male and most of the patients were from 19-35 year.(table 1)\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1\u0026nbsp;Socio-demographic characteristics of patients at clinic of Mizan prison (n=187)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"616\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.506493506493506%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.142857142857146%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.350649350649352%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.48701298701299%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01948051948052%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.142857142857146%\" valign=\"top\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.350649350649352%\" valign=\"top\"\u003e\n \u003cp\u003e67.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.18300653594771%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\" valign=\"top\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.6797385620915%\" valign=\"top\"\u003e\n \u003cp\u003e32.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.48701298701299%\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01948051948052%\" valign=\"top\"\u003e\n \u003cp\u003e15-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.142857142857146%\" valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.350649350649352%\" valign=\"top\"\u003e\n \u003cp\u003e24.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.18300653594771%\" valign=\"top\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\" valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.6797385620915%\" valign=\"top\"\u003e\n \u003cp\u003e33.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.18300653594771%\" valign=\"top\"\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\" valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.6797385620915%\" valign=\"top\"\u003e\n \u003cp\u003e18.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.18300653594771%\" valign=\"top\"\u003e\n \u003cp\u003e45-54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.6797385620915%\" valign=\"top\"\u003e\n \u003cp\u003e14.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.18300653594771%\" valign=\"top\"\u003e\n \u003cp\u003e55-64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.6797385620915%\" valign=\"top\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.18300653594771%\" valign=\"top\"\u003e\n \u003cp\u003eGreater than 64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.6797385620915%\" valign=\"top\"\u003e\n \u003cp\u003e0.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eThe Most Commonly Prescribed \u0026nbsp;Antibiotic At Clinic Of Mizan Prison\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong all patients medical records containing antibiotics commonly used antibiotics includes; Amoxicillin(36.96%) followed by metronidazole(13.04%), ciprofloxacin(8.70%), Tinidazole(8.70%), cloxaciliin(7.61%), B.penicillin(7.07%) Albendazole(6.52%), doxycyclline(6.52%) \u0026nbsp;and gentamicine (4.89%), others.(Figure 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommon diagnosis at clinic of Mizan prison \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most common reasons for which antibiotic prescribed was condition like community acquired pneumonia 60(31.25%), Typhoid 28(14.58%), Giardiasis 20(13.02%), Urinary Tract Infection 25(10.42%), Amobiasis14 (7.29%), Diarrhoea (6.25%), Tonsillitis 5(3.13%) and others 33(14.06%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnosis Strategies\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAt Clinic Of Mizan Prison\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut 187 patient 119(63.6%) were treated empirical, where as 24(12.8%) were stool, urine analysis 17( 9%) \u0026nbsp;and other 27(14.4%).(table 2)\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2\u0026nbsp;Diagnosis Strategies At Clinic Of Mizan Prison (n=187)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"505\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.08910891089109%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.702970297029704%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.20792079207921%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.08910891089109%\" valign=\"top\"\u003e\n \u003cp\u003eEmpirical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.702970297029704%\" valign=\"top\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.20792079207921%\" valign=\"top\"\u003e\n \u003cp\u003e63.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.08910891089109%\" valign=\"top\"\u003e\n \u003cp\u003eStool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.702970297029704%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.20792079207921%\" valign=\"top\"\u003e\n \u003cp\u003e12.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.08910891089109%\" valign=\"top\"\u003e\n \u003cp\u003eUrine analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.702970297029704%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.20792079207921%\" valign=\"top\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.08910891089109%\" valign=\"top\"\u003e\n \u003cp\u003eCBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.702970297029704%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.20792079207921%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.08910891089109%\" valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.702970297029704%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.20792079207921%\" valign=\"top\"\u003e\n \u003cp\u003e14.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAverage treatment duration, Reinfection and/or Relapse Status of Patient over the past 28 Days\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMajority 125(66.8%) of the patient were treated below three to five days \u0026nbsp;and 65(34.8%) were visit the clinic again for the same sign and symptoms over the past 28 days. (table 3)\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3\u0026nbsp;Average treatment duration, Reinfection and/or Relapse Status of Patient over the past 28 Days\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.45070422535211%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eVariable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eFrequency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.704225352112676%\" colspan=\"2\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDuration of treatment\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e1-2 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e14.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.42654028436019%\" valign=\"top\"\u003e\n \u003cp\u003e3-5 days\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.78672985781991%\" valign=\"top\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.78672985781991%\" valign=\"top\"\u003e\n \u003cp\u003e66.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.42654028436019%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt; 5 days\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.78672985781991%\" valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.78672985781991%\" valign=\"top\"\u003e\n \u003cp\u003e18.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.42654028436019%\" valign=\"top\"\u003e\n \u003cp\u003etotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.78672985781991%\" valign=\"top\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.78672985781991%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.573192239858905%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eNext visit over 28 days\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760141093474426%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e34.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.42654028436019%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.78672985781991%\" valign=\"top\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.78672985781991%\" valign=\"top\"\u003e\n \u003cp\u003e65.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.42654028436019%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003etotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.78672985781991%\" valign=\"top\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.78672985781991%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCommon Route and dosage of Administration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMajority of antibiotic Prescribed by Oral route 140(75.3%),Followed by \u0026nbsp;Parental route 13(6.9%).Regarding the dosage form of antibiotic Capsule 92(49.7%),Tablet 48(25.6%)and eye drop 14(7.4%) were the most commonly prescribed dosage form.(figure3)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison with Guidelines and Drug therapy problems related with antibiotics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e88.7% of the patient were treated irrespective of treatment guideline of Ethiopian standard treatment guideline 2021 (last edition), and need additional drug therapy was the predominant DTP which accounts around 47% of DTP observed followed by patient compliance (22%). (Table 4)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Comparison with Guidelines and Drug therapy problems related with antibiotics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"617\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.91896272285251%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.959481361426256%\" valign=\"top\"\u003e\n \u003cp\u003efrequency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.12155591572123%\" valign=\"top\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.959481361426256%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eTreatment According To Stg 2021\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.959481361426256%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.959481361426256%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.12155591572123%\" valign=\"top\"\u003e\n \u003cp\u003e11.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.47732181425486%\" valign=\"top\"\u003e\n \u003cp\u003e88.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.47732181425486%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.959481361426256%\" rowspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDrug Therapy Problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.959481361426256%\" valign=\"top\"\u003e\n \u003cp\u003eIneffective Drug\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.959481361426256%\" valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.12155591572123%\" valign=\"top\"\u003e\n \u003cp\u003e12.65%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003eNeed Additional Drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.47732181425486%\" valign=\"top\"\u003e\n \u003cp\u003e46.98%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003ePatient Compliance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.47732181425486%\" valign=\"top\"\u003e\n \u003cp\u003e22.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003eUnnecessary Drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.47732181425486%\" valign=\"top\"\u003e\n \u003cp\u003e6.02%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003eDose To Low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.47732181425486%\" valign=\"top\"\u003e\n \u003cp\u003e6.02%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003eDose To High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.47732181425486%\" valign=\"top\"\u003e\n \u003cp\u003e3.01%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003eAdverse Drug Interaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.47732181425486%\" valign=\"top\"\u003e\n \u003cp\u003e0.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.26133909287257%\" valign=\"top\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.47732181425486%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eAntibiotics are the key drugs for treatment of infections and are among the most commonly prescribed drugs in Mizan prison clinic. According to this study, the most frequently prescribed individual antimicrobial agents were amoxicillin, metronidazole, ciprofloxacilin, B.penicillin, Tinidazole and doxycycline slight diffrence were observed compared to Study done on antibiotic utilization pattern in a italy prison were the most frequently prescribed antimicrobial was amoxicillin and clavulanic acid, followed by amoxicillin, macrolides and third-generation cephalosporin\u0026rsquo;s and this variation is possibly justified by being different setting and availability of potential alternative antibiotic in the setting. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis was different from other study done in Nekemte showed that,. From the total of antibiotics, cotrimoxazole was the most frequently prescribed followed by amoxicillin and also chloramphenicol, gentamicine, cephalexin, and crystalline penicillin.\u003c/p\u003e \u003cp\u003eThe study done in Nekemte showed that, the total of drugs including antibiotics were prescribed to the total of 341 patients; out of which 373 were antibiotics. From the total of antibiotics, cotrimoxazole was the most frequently prescribed followed by amoxicillin and also chloramphenicol, gentamicine, cephalexin, ceftriaxone, crystalline penicillin. Doxycycline and procaine Penicillin Fortified were prescribed for only two patients each and norfloxacin and azithromycin were prescribed for one patient each. In this study the most commonly prescribed classes of antibiotics includes penicillin followed by sulfonamides, cephalosporin and the least prescribed class was macrolides and tetracycline [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConcerning to the clinical indication, this study showed that the most common reason for which antibiotics prescribed was community acquired pneumonia followed by typhoid, urinary tract infection, Giardiasis, amobiasis, diarrhea, tonsillitis, eye infection and others.\u003c/p\u003e \u003cp\u003eSimilar study done in Saudi Arabia showed that the most prevalent indications for prescribing were respiratory tract infections. All antibiotics prescribed were broad-spectrum. Antibiotics were prescribed for patients with malaria and also in situations where diagnosis was uncertain [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].and also similar study in Italy prison showed that, URTI and dental infections. Among the URTI, pharyngitis, acute bronchitis, influenza, common cold, and were rhino-sinusitis, where as among dental infections symptomatic irreversible pulpits with or without symptomatic apical periodontitis, and pulp necrosis and symptomatic apical periodontitis/pulp necrosis and localized acute apical abscess [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding to the route of administration, the majority 140(49.7%) of antimicrobial were prescribed by oral followed by parenteral 13(6.9%), syrup12 (6.4%), and eyedrop14 (7.4%). This was similar with study done in Italy prison the route of administration was oral in 84.8% and intramuscular.\u003c/p\u003e \u003cp\u003eIn this study, the empirical diagnosis is 129(68.9%) and laboratory diagnosis 58(31%) antimicrobial agents were amoxicillin, doxycycline, ciprofloxacilin, B.penicillin, Tinidazole, albendazole, gentamicine and metronidazole, this is because those drugs can be used in a wide variety of disease conditions in clinic patients, easily availability ,available in different dosage forms, preferred in severe cases due to its fast onset of action.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study gives an overview of antibiotic utilization in clinic of Mizan prison.amoxaicilin, metronidazole, ciprofloxacilin were the most frequently prescribed individual drugs. community acquired pneumonia was most prevalent disease followed by, typhoid and typhus, urinary tract infection, was found to be primary case for clinic visit among prisoners.\u003c/p\u003e\n\u003cp\u003eThe percentage of oral drugs was very high compared to drugs administered through parenterally. Ineffective drug therapy, need additional drug therapy, unnecessary drug therapy most encountered drug therapy problem followed by dose too high, dose too low, adverse drug reaction and patient compliance\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to recommend\u0026hellip;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eThe\u0026nbsp;prescribers and pharmacist in prison clinic should prescribe and dispense antimicrobials according to the STG .\u003c/li\u003e\n \u003cli\u003eThe prison should provide enough drugs.\u003c/li\u003e\n \u003cli\u003eThe prison should increase human resource for clinic.\u003c/li\u003e\n \u003cli\u003eThe pharmacists in prison clinic should encourage the prisoners to take drugs according to correct route, dose and frequency.\u003c/li\u003e\n \u003cli\u003eThe pharmacist to counsel the patients accordingly and correctly.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAR; antimicrobial resistance, DUE; drug use evaluation, DTC; drug therapeutic commute, DTC; drug therapy problem , EDL;essential drug list, WHO; world health organization, STG; standard treatment guideline\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge Mizan prison administrative and health care provider for their cooperation and support during the data collection period .\u003c/p\u003e\n\u003cp\u003eFunding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis work was not funded by anyone.\u003c/p\u003e\n\u003cp\u003eDeclarations\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the institutional review board of Mizan Tepi University, college of Medicine and Health. Letter of permission was presented to the managements of Mizan prison who allowed us to use patients\u0026rsquo; medical records. Patients\u0026rsquo; information such as name and address of\u0026nbsp;the patients was not recorded . This study did not involve human experiments or human tissue .\u0026nbsp;All findings in this paper were performed in accordance with relevant guidelines and regulations (such as the Declaration of Helsinki).\u003c/p\u003e\n\u003cp\u003eConsent for publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable to this work.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential competing of interest concerning the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003eData availability\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll the datasets used/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eConflict of interest\u003c/p\u003e\n\u003cp\u003eAll authors declare \u0026nbsp;no conflict of interest.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; Contributions\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; Contributions\u003c/p\u003e\n\u003cp\u003eAll authors contributed to data analysis, drafting, or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published,and agree to be accountable for all aspects of the work. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCDC Antibiotic use in the United States. Antibiotic use in the United States, 2017. Progress and opportunities. Atlanta US Department of Health and Human Service, CDC;2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHulscher ME, Grol RP,van der Merr JW. Antibiotic prescribing in hospitals: a social and behavioural scientific approach. Lancet Infect Dis. 2018;10(3):167\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKardas P, Devine S, Golembsky A, Roberts C. A systemic review and meta-analysis of misuse of antibiotic therapies in the community. Int J Antimicrob Agents.2018;26(2):10613.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuglielemo BJ Practical strategies for appropriate use of antimicrobial. Pharm World Sci 2018,17:96\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhillips MS, Gayman JE, Todd MW,ASHP guidelines on medication-use evaluation. American society of Health-system Pharmacists. Am J Health Syst Pharm 2017,53: 1953\u0026ndash;1955.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWise R, Hart T, Cars O, Strenulens M, Helmuth R, Huovinen P, Sprenger M. Antimicrobial resistance. Is a major threat to public health.BMJ. 2017 Sep5;317(7159):609\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDajani R, Hart T,Cars O, Streulens M,Helmuth R, Huovinen P, Sprenger M. Antimicrobial resistance. Is a major threat to public health.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Ten Threats to Global Health in 2019. Available online: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/spotlight/ten-threats-to global-health-in-2019\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/spotlight/ten-threats-to global-health-in-2019\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (accessed on 13 October 2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThapaliya K, Shrestha S, Bhattarai S, Basnet D, Chaudhary RM, 2015, Prescribing Pattern of Antibiotics in Pediatric hospital in chitwan district in Nepal, world journal of pharmacy and pharmaceutical sciences; 4(11): 1631-41\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinyahil A. Woldu, Suleman S, Workneh N, and Berhane H, 2013, Retrospective Study of the Pattern of Antibiotic Use in Hawassa University Referral Hospital Pediatric Ward, Southern Ethiopia,Journal of Applied Pharmaceutical Science; 3 (02):093\u0026ndash;098\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNobile, C.G.; Flotta, D.; Nicotera, G.; Pileggi, C.; Angelillo, I.F. Self-reported health status and access to health services in a sample of prisoners in Italy. BMC Public Health 2011, \u003cem\u003e11\u003c/em\u003e, 529.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMassoglia, M.; Pridemore, W.A. Incarceration and Health. annu. Rev. Sociol. 2015, \u003cem\u003e41\u003c/em\u003e, 291\u0026ndash;310.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePereira LP, Phillips M, Ramlal H, Teemul K, Prabhakar P. Third genera\u0026ndash; tion cephalosporin use in a tertiary hospital in Port of Spain, Trini\u0026ndash; dad: need for an antibiotic policy. BMC Infect Dis. 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1471\u0026ndash;2334\u0026ndash;4\u003c/span\u003e\u003cspan address=\"10.1186/1471\u0026ndash;2334\u0026ndash;4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDajani AS. Adherence to physicians' instructions as a factor in managing streptococcal pharyngitis. Pediatrics. 2016,Jun;97(6 Pt 2):976\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePech\u0026egrave;re JC. Parameters important in short antibiotic courses. J Int Med Res. 2019;28 Suppl 1:3A-12A.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSclar DA, Tartaglione TA, Fine MJ. Overview of issues related to medical compliance with implications for the outpatient management of infectious diseases. Infect Agents Dis. 2019;3(5):266\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGetachew E, Aragaw S, Adissie W, and Agalu A, 2013, Antibiotic prescribing pattern in a referral hospital in Ethiopia,Global Journal of Pharmacy and Pharmacology;1 (1): 078\u0026ndash;082\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Giuseppe, G.; Lanzano, R.; Silvestro, A.; Napolitano, F.; Pavia, M. Pattern and Appropriateness of Antimicrobial Prescriptions for Upper Respiratory Tract and Dental Infections in Male Prisoners in Italy.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenkateswaramurthy N, Murali R Sampathkumar R, 2012, The study of drug utilization pattern in pediatric patients. International Journal of Pharmacy and Pharmaceutical Sciences; 5(03): 140\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlakhali K, Shaik Mohammad A, 2014, Prescribing Pattern of Antibiotics in Pediatric Patients in the Jazan Region, Kingdom of Saudi Arabia, RGUHS J Pharm Sci; 4 (3)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChem ED, AnongDN, Akoachere J-FKT Prescribing patterns and associated factors of antibiotic prescription in primary health care facilities of Kumbo East and Kumbo West Health Districts, North West Cameroon. PLoS ONE2018, 13(3)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOumer Abdu Muhie, Antibiotic Use and Resistance Pattern in Ethiopia: Systematic Review and Meta-Analysis, International Journal of Microbiology 2019,8\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsefa L, Bayissa G, and Abera Z,2016, Antibiotics Use Evaluation for Pediatrics at Nekemte Referral Hospital, East Wollega Zone, Oromia Region, West Ethiopia, World Journal of Medical Sciences; 13 (1):17\u0026ndash;26\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFederal Bureau of Prisons Antimicrobial Stewardship Guidance Clinical Practice Guidelines March 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eE.L tover, et al Antibiotic utilization in a specialized teaching hospital in Ethiopia (adiss abeba),clinical therapeutics 2017,39,84\u0026thinsp;\u0026ndash;\u0026thinsp;65.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Mizan Tepi University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Antibiotic, Utilization, Clinic, Prison, Pattern","lastPublishedDoi":"10.21203/rs.3.rs-3936906/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3936906/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAntibiotics are strong and effective medicines which are used to treat most different bacterial infections. Antibiotics prescribing should be appropriate and restricted since inappropriate use may contribute to the emergence of resistant microorganisms may lead to unnecessary adverse drug events and has been associated with increased health care costs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThe aim of this study was to assess antibiotic utilization pattern in clinic of Mizan prison. from August 1-October 30, 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eRetrospective cross sectional study was conducted in clinic of Mizan prison to assess antibiotic utilization pattern from August 1-October 30, 2023.The data was analyzed by using Statistical Package for Social Sciences (SPSS) Version 21.0\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eThis study was intended to assess antimicrobial utilization pattern, a total of 187 medical records containing antimicrobial agents were evaluated and analyzed at clinic of Mizan prison. From a total patients, number of male patients 127(67.9%) and females 60(32%).Most of the patients were from 19-35 age and the least number of patients belonged to age group of ≥69.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e :This study gives an overview of antibiotic utilization in clinic of Mizan prison. amoxaicilin, metronidazole, ciprofloxacin were the most frequently prescribed individual drugs.Ineffective drug therapy, need additional drug therapy, unnecessary drug therapy most encountered drug therapy problem followed by dose too high, dose too low, adverse drug reaction and patient compliance.\u003c/p\u003e","manuscriptTitle":"Assessment of Antibiotic Utilization Pateern, Comparision With Guidelines and Infection Diagnosis Strategies at the Clinic of Mizan Prison, Bench Sheko Zone, South-west Ethiopia Retrospective Cross Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-09 20:32:26","doi":"10.21203/rs.3.rs-3936906/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5e0553ae-0906-414f-8f25-fa2c0f982d54","owner":[],"postedDate":"February 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-09T20:32:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-09 20:32:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3936906","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3936906","identity":"rs-3936906","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}