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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 3140 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 (10,232,59) 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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The articles in Bibliomed are open access articles licensed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (https://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.