the study was carried out in the ent opd and ipd of majeedia hospital , a 150-bed teaching hospital situated in hamdard university , new delhi , india . it was a prospective study and was based on a medication utilization form , which has been designed on the basis of a who format . an oral and written consent was obtained from the patients before their participation in the study . the present study was conducted on 276 patients who visited the opd and ipd of ent department during the 4-month period . the subjects who had willingly participated were enrolled on the basis of inclusion and exclusion criteria . all the patients using antibacterials , irrespective of age and sex , including pregnant and lactating patients were studied . however , patients who were not treated with antibacterials or were unable to comply due to mental retardation , unconsciousness or drug addiction were excluded . the present study followed some who / inrud indicators in addition to some other useful indicators . the parameters included gender distribution , average age range of patients , types of infections , types of antibacterial prescribed , most commonly used agents of a particular class , average number of antibacterials per prescription , comparison of antibacterials prescribed in monotherapy versus fixed dose combination therapy , mode of administration , comparison of antibacterials prescribed by generic versus brand name , concomitant diseased conditions , compliance or adherence ( using weekly diary cards ) . the sources of data were physicians prescribing records , patient 's medication profile and weekly diary cards . patient profile ( age , sex , weight , height , patient 's address ) , drugs prescribed ( generic / brand name ) , doses and frequency were recorded . the study was carried out in the ent opd and ipd of majeedia hospital , a 150-bed teaching hospital situated in hamdard university , new delhi , india . it was a prospective study and was based on a medication utilization form , which has been designed on the basis of a who format . an oral and written consent was obtained from the patients before their participation in the study . the present study was conducted on 276 patients who visited the opd and ipd of ent department during the 4-month period . the subjects who had willingly participated were enrolled on the basis of inclusion and exclusion criteria . all the patients using antibacterials , irrespective of age and sex , including pregnant and lactating patients were studied . however , patients who were not treated with antibacterials or were unable to comply due to mental retardation , unconsciousness or drug addiction were excluded . the present study followed some who / inrud indicators in addition to some other useful indicators . the parameters included gender distribution , average age range of patients , types of infections , types of antibacterial prescribed , most commonly used agents of a particular class , average number of antibacterials per prescription , comparison of antibacterials prescribed in monotherapy versus fixed dose combination therapy , mode of administration , comparison of antibacterials prescribed by generic versus brand name , concomitant diseased conditions , compliance or adherence ( using weekly diary cards ) . the sources of data were physicians prescribing records , patient 's medication profile and weekly diary cards . patient profile ( age , sex , weight , height , patient 's address ) , drugs prescribed ( generic / brand name ) , doses and frequency were recorded . a total of around 3100 patients visited the ent opd and ipd , over a period of 4 months . on the basis of inclusion and exclusion criteria , 276 patients were selected for the present study . among the 276 ent patients , 173 were male and 103 were female . the highest number of patients were in the age group 1625 years and the lowest percentage was geriatric patients [ table 1 ] . during the study , it was observed that 103 patients visited for treating ear infection , 41 for nose infections , 100 for throat infections and 32 for combination of ent infections [ table 2 ] . age distribution amongst ent patients types of ent infections during the study , it was observed that the most commonly prescribed antibacterials were -lactam ( penicillins and cephalosporins)-199 , followed by quinolones-115 , macrolides-54 , chloramphenicol-43 , tetracyclines-17 and aminoglycosides-9 [ table 3 ] . the most commonly used agent of these classes , i.e , -lactam was penicillins ( amoxicillin with clavulanic acid-95 ) and cephalosporins ( cefpodoxime proxetil-24 ) followed by quinolones ( gemifloxacin-63 , chloramphenicol-43 ) , macrolides ( azithromycin-38 ) , tetracyclines ( doxycycline-16 ) and aminoglycoside ( neomycin with polymyxin b-6 ) [ table 4 ] . type of antibacterials prescribed for ent infections most commonly used antimicrobials agents the prescription of patients showed that a total of 184 patients received antibacterial monotherapy , whereas 92 patients were on multiple drug therapy . among those who were treated with drug combinations , 62 received two drugs , 18 received three drugs and 12 received four drug regimens [ table 5 ] . the average number of antibacterial agents prescribed per patient per course was found to be 1.58 . their routes of administration were oral ( 309 ) , intravenous ( 72 ) and ear drop ( 56 ) . the most frequent comorbid condition of the study population was found to be diabetes ( 10.50% ) followed by hypertension ( 6.16% ) and coronary artery disease ( 5.07% ) [ table 6 ] . weekly diary cards were used for daily drug intake to monitor adherence to the prescribed dosage regimen . the standard criteria for noncompliance were < 80% of the recommended intake of prescribed drugs . in the present study , 135 of total patients showed a good adherence with the prescribed treatment . prescription by a doctor may be taken as a reflection of physician 's attitude to the disease and role of the drug in treatment . little information exists about the prescriptive behavior of physicians and the misuse of antibacterials in the management of outpatient and inpatient with ent infections . in general practice , the therapeutic approach for ent infections is nearly empirical and the main aim of physicians is to treat as specifically as possible , while covering the most likely pathogens . the present descriptive study indicates general trends of prescribing in the opd and ipd of ent department . demographic characteristics showed that percentage of males suffering from ent infections was more than females . many other studies showed that females are more sensitive to ent infections than males ; the reason might be their exposure to kitchen smoke . in our study , the observed percentage of males was predominant which might be due to the occupational reasons . further , it was found that a majority of the patients were in the age group of 1625 years and the lowest percentages were in geriatric group . few studies have reported that majority of patients fell in different age groups like 4560 years and greater than 60 years with respiratory infections . patients suffering from various acute and chronic ent infections were treated with different antibacterial agents . in our study , the number of patients with om was maximum , however the cases of acute and chronic suppurative om ( asom and csom ) with other ear infections were also observed . the cases of epistaxis , sinusitis and allergic rhinitis predominate in nose - infected patients . however , sore throat , acute pharyngitis and tonsillitis were the maximum cases of throat - infected patients . it was an interesting observation that a significant number of patients with combination of ent patients suffered from urtis alone or along with om and other infections . most commonly prescribed categories of antibacterials were found to be -lactam ( 45.52% ) , followed by quinolones ( 26.31% ) and macrolides ( 12.12% ) . the chloramphenicol and tetracyclines constituted only 9.84 and 3.89% , respectively . among the individual antibiotic drugs , maximum patients received a combination of amoxicillin with clavulanic acid ( 21.74% ) , followed by gemifloxacin ( 14.41% ) , chloramphenicol ( 9.84% ) , azithromycin ( 8.69% ) , cefpodoxime proxetil ( 5.49% ) and doxycycline ( 3.66% ) . in a study , das et al . reported that ciprofloxacin ( 23.85% ) was preferred , followed by amoxycillin ( 20.06% ) , a combination of ampicillin + cloxacillin ( 9.17% ) , doxycyclin ( 5.96% ) , erythromycin ( 4.58% ) and co - trimoxazole ( 4.58% ) . clavulanate , cefdinir , cefpodoxime proxetil and cefuroxime axetil are all considered appropriate for the initial treatment of acute bacterial rhinosinusitis in children . so , the use of azithromycin and clarithromycin should be indicated only when their broad coverage is required or when other antibiotic use is prohibited due to allergy , etc . however , a change in the prescribing patterns from a small spectrum to penicillin to amoxicillin / clavulanate , as indicative in our study , could be due to an increase in antibiotic resistance which encourages physicians to choose a broader and safer option . the mean number of antibacterial agents prescribed per patient per course was found to be 1.58 . in a similar study , das et al . reported 1.4 antimicrobial agents per patient in outpatient services of ent department in a tertiary care hospital of eastern nepal . hence , physicians should preferably keep the mean number of drugs per prescription as low as possible as higher figures always lead to increased risk of drug interaction , development of bacterial resistance and increased cost . further , 66.67% patients received antibacterial monotherapy ; whereas 33.33% patients were on multiple drug therapy . das et al . have reported that single drugs were prescribed the maximum ( 89.52% ) , followed by two drugs ( 9.94% ) and three drugs ( 0.52% ) in ent patients. in the present study , the routes of administration of antibacterials were found to be oral 70.71% , parenteral ( i.v . ) 16.48% and topical ( via ear drop ) 12.81% . shankar et al . have carried out a prospective study where 48.9% antibacterial agents were prescribed by the parenteral route . in our study , it was found that all the antibacterial agents were prescribed by their brand names only , which could be due to the influence of medicinal drug promotional activities . prescribing the brand name may undermine some of the goals of essential drug concept . on the other hand , prescribing by generic names may reduce overall expenditure on drugs , especially on newer antibiotics , etc . a significant number ( 32.2% ) of the most frequent comorbid condition of the study population was found to be diabetes ( 10.5% ) , followed by hypertension ( 6.16% ) , coronary artery disease ( 5.07% ) , hypothyroidism and rheumatoid arthritis . in a similar study , mazzaglia et al . have reported liver disease as the most concomitant condition , followed by diabetes mellitus , heart disease , ischemic heart disease , malignant neoplasm in acute urtis . have reported that the rate of chronic disease was highest in italy ( 52% ) and lowest in spain ( 38% ) . therefore , our study indicates that the percentage of concomitant disease ( 32.2% ) was lower than the percentage found in italy and spain , whereas diabetes was reported to be common concomitant condition against liver disease in the above mentioned literature . in our study , only 135 ( 48.91% ) patients had taken the drugs properly . cost of antibiotics could be one of the major contributing factors for noncompliance in a developing country like india . the study was carried out over a 4-month period , and seasonal variations in disease pattern and drug utilization were not considered . further , the number of patients was low and the study was restricted to only one hospital , hence the results can not be considered representative of the whole country . however , in spite of all these limitations , our study highlighted some rational prescribing practices . continuing education on rational drug use and development of easy to use treatment guidelines for common diseases is suggested . in our future endeavors , we plan to study the effect of regulatory and educational interventions on drug use pattern in the management of ent infection . to conclude , our study in the university teaching hospital highlighted lesser utilization of antibacterials in ent infections , as some of the ent infections are not due to bacteria . it appears that majority of the ent patients visiting the hospital have infections primarily due to bacteria and most of the patients responded well to the use of antibiotics .
objective : we explored the antibacterial prescribing patterns of physicians in ear , nose and throat ( ent ) outpatient and inpatient departments ( opd , ipd ) of a university hospital , new delhi , india.materials and methods : a prospective study was conducted , with a sample size of 276 patients , who visited the ent opd and ipd over a period of 4 months.results:it was found that 62.68% were males , 26% patients were in the age group 26 - 35 years , followed by 22.8% belonging to the age group 2635 years . maximum number of patients were diagnosed with ear ( 37.3% ) and throat ( 36.2% ) infections . 
 the most frequently prescribed antibacterials were -lactams ( 45.52% ) followed by quinolones ( 26.31% ) . 
 the most commonly used agent in penicillins was amoxicillin and clavulanic acid ( 21.74% ) , in cepahalosporins was cefpodoxime proxetil ( 5.49% ) and in quinolones was gemifloxacin ( 14.41% ) . 
 further , 66.67% of the patients received single antibacterial drug and the average number of antibacterial agents prescribed per patient per course was found to be 1.58 . 
 it was also observed that 70.71% of the antibacterials were prescribed by oral route . 
 the most concomitant conditions were found to be diabetes ( 10.5% ) , hypertension ( 6.16% ) and coronary heart disease ( 5.07% ) . 
 all the drugs were prescribed by their brand names and 48.91% patients showed good adherence with the prescribed therapy.conclusions:the present work is the maiden drug utilization study conducted in ent department at our university hospital . 
 it highlighted some rational prescription patterns including less utilization of antibiotics in ent infections , good adherence by patients and prescription by brand names . 
 the data presented here will be useful in future , long - term and more extensive drug utilization studies in the hospital and in promotion of rational prescribing and drug use in hospitals .