Drug Prescription Pattern for Leptospirosis and Association with Outcome: Observations from a Tertiary Care Center

Abstract

Background: Leptospirosis, an infection of the tropics, caused by helical spirochetes, Genus Leptospira. For the first time, this study examines the pattern of antibiotic prescription for leptospirosis and its association with outcome. Materials and Methods: This was a hospital-based retrospective study. A total of 227 adults diagnosed and treated for leptospirosis during the study period of January 2013 to December 2018 were included in the study. Information on gender, age, admission details, outcome, inpatient days, and antibiotics used was collected from the patients’ records and analyzed. Results: Around 75% of the leptospirosis patients were male and majority (70.4%) of the patients were from the age group of 31–60 years. Most of the patients (43.6%) were admitted for 6–10 days; 27.3% of the patients were admitted in the intensive care unit (ICU) and the mortality rate was 7.49%. Ceftriaxone was the most (53.3%) prescribed intravenous antimicrobial, followed by piperacillin–tazobactum (32.6%), and among oral antimicrobials, doxycycline was prescribed in 37.4% of the patients. Penicillin was administered to 44 patients with mild disease and all survived. Among the Ceftriaxone and piperacillin–tazobactum prescribed, 26.5% (32/121) and 35% (26/74) were admitted in ICU, respectively. Among the patients with severe disease, who succumbed to leptospirosis, ceftriaxone, and piperacillin–tazobactam were prescribed in 8.28% and 4.05%, respectively. Conclusion: The pattern of antibiotics prescribed in the study center was in accordance with the standard guidelines. The prescriptions were predominantly penicillin and doxycycline in early conditions while ceftriaxone and piperacillin–tazobactum were administered in advance/severe conditions. Patients with mild disease recovered with penicillin, while in advanced disease, even administration of third cephalosporins and doxycycline had a poor prognosis leading to death of the patients, indicating the need for early diagnosis and treatment to be important to prevent mortality.