INTRODUCTION
Adults and children generally are affected by diseases of the ear, nose, and throat (ENT), which can cause severe impairment in patients’ daily lives [1]. With the growing global population, infections are expected to remain the leading cause of disease, with upper respiratory tract infections (URTIs) causing hearing loss and learning disabilities. The World Health Organization (WHO) reported in its World Health Report that respiratory infections caused 94.6 disability adjusted life years lost worldwide and were the fourth leading cause of death, accounting for 4.0 million fatalities or 6.9% of all deaths.
In a general hospital, acute respiratory infections account for 20-40% of outpatient visits and 12-35 percent of inpatient stays. URTIs, which include nasopharyngitis, pharyngitis, tonsillitis, and otitis media (OM), account for 87.5 percent of all respiratory infection episodes. They are a major cause of morbidity and workplace absenteeism. Viruses cause the great majority of acute URTIs. In most cases, a common cold is caused by viruses and does not require the use of antimicrobials unless it is accompanied by acute OM with effusion, tonsillitis, sinusitis, or a lower respiratory tract infection. Because most occurrences of rhino sinusitis are viral, they recover on their own without the need for antibiotics [2]. Antibiotics were mostly administered for respiratory and ENT diseases having a viral aetiology, like rhino-pharyngitis and severe bronchitis. Antibiotic prescriptions are written in around 40% of all consultations for rhino-pharyngitis and in about 80% of those for acute bronchitis, according to the findings of the various surveys. Antibiotics were administered in more than 90% of pharyngitis cases, regardless of the patient’s age. In contrast, the frequency of consultations for acute middle ear infections has stayed essentially stable over the last ten years, while antibiotic prescriptions have climbed dramatically, reaching 80 percent of consultations. Antibiotic prescription diversity is due to true variances in infecting organisms and antimicrobial susceptibility from country to country or even region to region, but other factors may also be at play, such as physician choice, local policy, costs, and a lack of local guidelines [3]. The current global rise in antibiotic-resistant bacteria, along with a lower trend in new antibiotic discovery, has major health and economic ramifications. Antibiotics are widely misused, including use based on false medical grounds, as well as misuse involving the improper agent, administration method, dose, and treatment duration. Antibiotic use results in the development of resistance as a natural biological process. “Poor patient adherence to dose regimens and the administration of substandard antibiotics result in suboptimal concentrations that fail to treat infection and may promote the formation of resistant bacterial populations; hence, underuse, irrational use, and overuse may both play a role in promoting resistance.” At this time, there is no such thing as an ideal antibiotic, and the overuse of broad-spectrum antibiotics in respiratory infections leads to resistance development in pathogenic bacteria as well as the patient’s normal bacterial reservoir [4]. Asia is one of the regions with the most serious resistance issues. The prevalence of resistant pneumococci in Asian countries, in particular, have been worrying. In India, bacteria resistant to ampicillin, trimethoprim, nalidixic acid, and chloramphenicol are found in nearly every healthy person [5]. Despite the fact that antibiotics have been used in clinical practice for many years, little is understood about how they should be used best in the clinic. How antibiotics should be delivered clinically to reduce resistance development while maintaining safety and efficacy is a crucial and largely unresolved subject. There is a need for data on both antibiotic use and determinants of use from all regions in the world. In too many countries there is no adequate surveillance of prescribing, of drug quality, or of the resistance problem. Through European surveillance of antimicrobial consumption (ESAC) project, significant improvements in the surveillance of antibiotic use in Europe have been achieved. However, a global approach is needed where comparable data are generated [6]. Therefore, studies reflecting drug utilization are required, as they assess the appropriateness of drug therapy. Drug use evaluation is an ongoing, authorized, and systemic quality improvement process that is designed to review the drugs that are prescribed to patients, provide appropriate feedback to clinicians/other relevant groups, develop criteria and standards that describe optimal drug use, and educate and counsel patients on appropriate drug use. Prospective drug utilization studies can directly influence patient treatment and outcome. Pharmacovigilance of antibiotics for its safer use is also essential; the overall purpose of pharmacovigilance is improvement in the safety of medicines (WHO, 2004). The estimation of the probability that a drug caused adverse clinical event is usually based on clinical judgment. Using the conventional categories and the criteria of definite, probable, possible and doubtful adverse drug reaction generates wide variability scales (Naranjo’s and WHO’s probability scale). The Naranjo’s scale categorizes the reaction as highly probable, probable, possible and unlikely; this probability scale is based on simple questionnaire that can be answered rapidly [7], this scale is easier and time saving as compared to WHO’s probability scale.
Hence, the present prospective study was aimed to evaluate drug utilization pattern and adverse drug reaction monitoring of antibiotics use in ear, nose and throat infections.