Antibiotic Prescribing Among Inpatients with Ophthalmic Diagnoses: A Decade of Evidence from Two Private-Sector Indian Hospitals.

OBJECTIVES

To describe and compare decadal antibiotic prescribing patterns and trends by diagnosis groups among ophthalmology inpatients at two private-sector hospitals in Central India.

METHODS

This observational surveillance study was conducted prospectively for a decade in the ophthalmology inpatient departments of a teaching hospital (TH) and a non-teaching hospital (NTH). Patient-level data on demographics, diagnoses, and antibiotic prescriptions were collected by nurses using a standardised form. Antibiotic utilisation was analysed using WHO's Anatomical Therapeutic Chemical (ATC) codes and Defined Daily Doses (DDDs), as well as AWaRe groups (Access, Watch, Reserve). Diagnoses were classified into infectious and non-infectious categories, and surgical and non-surgical groups. Prescribing trends were analysed using descriptive statistics and linear regression models.

RESULTS

Of 7561 patients (TH: 7305; NTH: 256), antibiotics were prescribed to almost all inpatients (TH: 99%; NTH: 90%). Fluoroquinolones were the most prescribed (TH: 94%; NTH: 71%), predominantly by the oral route (73%). Access-group antibiotics were considerably under-prescribed relative to WHO targets (TH: 3%; NTH: 4%). Watch-group antibiotics comprised 97% (TH) and 96% (NTH) of all prescribed antibiotics, and their prescribing increased significantly over 10 years (p < 0.05).

CONCLUSIONS

Watch-group fluoroquinolones dominated antibiotic prescribing at both hospitals and increased over the study period. Access-group antibiotics were substantially underutilised. These findings highlight an urgent need for context-specific antibiotic prescribing guidelines and stewardship programmes in ophthalmology settings in LMICs.