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A study on antimicrobial use in the management of duodenal perforation and its cost-effective analysis

Ellabathini Hima Bindu, Merughu Padma Latha, Mohathasim Billah A, Rizwan Uz Zaman.


Background: Duodenal perforation is mostly seen in gastrointestinal perforation due to either disease or trauma, which forms nearly one-third of acute abdominal catastrophe. Although modern sophisticated gadgets are available in the diagnostic armamentarium, proper history elicitation, methodological physical examination, and sharp clinical observation play a major role in accurate diagnosis of acute abdominal conditions. In duodenal perforation, there is a sudden release of gastric contents into peritoneal cavity, which leads to a devastating sequence of events such as chemical and bacterial peritonitis, fluid and electrolyte imbalance, toxemia, septicemia, circulatory failure, and finally death.

Aims and Objectives: The aim of this study was to evaluate the use of antibiotics in the management of duodenal perforation. This was a non-invasive prospective observational study. Seventy-nine patients with duodenal perforation undergoing elective and emergency surgery from the surgery wards were selected for the study on satisfying the inclusion criteria.

Materials and Methods: The study method involves the selection of patients based on the inclusion and exclusion criteria, to record the prescribing pattern of antibiotics in the post-operative wards of surgery, to find the effectiveness of the antibiotics prescribed in relation to the number of hospital days, and to analyze the cost-effectiveness using statistical tool. This study was conducted from May 2018 to October 2018.

Results: Data were collected from 79 patients. It was observed that the incidence of perforation was higher in males than females (7:1) in the age group of 31–40 years (28%) and mean Li-standard deviation is 11.28 ± 7.63. Pip/taz was most commonly prescribed (29 out of 79 cases). In terms of cost, on an average, pip/taz was found to involve highest amount. When the mean deviation of hospital stay was taken into account, piperacillin was at lower margin when compared with others (10.23 ± 2.59). The statistical analysis of hospital stay shows a significant difference between all three drugs Cefotaxime, ceftriaxone and cefixime (P ≤ 0.017, P ≤ 0.0139, and P ≤ 0.085, respectively). Thus, 26 patients out of 29 patients were successfully cured with pip/taz with a mean hospital stay of (10,23±2,59) days and three patients were discharged against medical advice. We considered cost effective involved in the treatment with drugs as health-care cost in rupees and number of days taken to cure as clinical outcome. From this, we calculated average cost-effective ratio and the highest being pip/taz (109.29) when compared to cefotaxime (97.1).

Conclusions: From our study, we conclude that piperacillin/tazobactam should be the choice of antimicrobials for this duodenal perforation.

Key words: Duodenal Perforation; Antimicrobial; Cost-Effective Analysis; Piperacillin/Tazobactam

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