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Drug Utilization Pattern in the Intensive Care Unit of a Tertiary Care Hospital
S. Biswal, P. Mishra, S. Malhotra, G. D. Puri and P. Pandhi
J. Clin. Pharmacol. 2006; 46; 945
DOI: 10.1177/0091270006289845

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Drug Utilization Pattern in the Intensive Care
Unit of a Tertiary Care Hospital
S. Biswal, P. Mishra, S. Malhotra, G. D. Puri, and P. Pandhi
The authors studied the factors affecting drug use pattern,
cost of therapy, and the association between the pattern of
drug use and survival as well as the duration of stay in a
prospective, observational study in an intensive care unit
between February and May 2005. Data were collected
regarding drugs used, severity of the disease, and their
outcome. The mean ± SD of the Acute Physiology and
Chronic Health Evaluation (APACHE III) and Glasgow
Coma Scale (GCS) scores of 84 patients were 52.2 ± 19.4
and 7.5 ± 2.4, respectively. Although the mean number of
drugs at the time of admission to the intensive care unit
was 5.3, it increased to 12.9 on the first day and 22.2 during
I ntensive care units (ICUs) care for the most seri-
ously ill patients. Therefore, a number of drugs
are employed to save these patients, of which some
are therapeutic, whereas others are prophylactic in
nature. The cost impact of ICU drug use on a hospi-
tal′s total drug use can be tremendous. In 1 study
carried out by Weber et al,1 ICU drug costs accounted
for 38.4% of the total drug costs and have increased
at a rate greater than non-ICU drug costs (12% vs
6%). The ICU pharmacy charges ranked as the fourth
most costly among the various ICU charges, with an
average of 11.1% of the total ICU charges.
Even though there are a number of guidelines
regarding proper drug use in ICUs, sometimes it may
not be possible to implement them because of patient-
specific disease states, the resident learning curve,
and physician medication preferences.2 The applica-
tion of simple techniques of drug utilization has
proved to be a useful, inexpensive tool for creating
From the Departments of Pharmacology (S. Biswal, S. Malhotra, P.
Pandhi) and Anesthesiology (P. Mishra, G. D. Puri), Postgraduate Institute
of Medical Education & Research, Chandigarh, India. S. Malhotra and
P. Pandhi are Fellows of the American College of Clinical Pharmacology
(FCP). Submitted for publication November 18, 2005; revised version
accepted April 17, 2006.
DOI: 10.1177/0091270006289845
J Clin Pharmacol 2006;46:945-951
PHARMACOEPIDEMIOLOGY
the entire stay. More than 50% of the average expenditure on
drugs and nutrition was accounted by antibiotics. Require-
ment of insulin or inotropes signified an adverse outcome
on mortality (odds ratios of 3.43 and 8.44, respectively). In
conclusion, there is a tremendous impact of antibiotic use
on the cost of therapy in the intensive care unit. The require-
ment of certain drugs such as insulin and inotropes is of
prognostic significance.
Keywords: Drug utilization; pattern; ICU
Journal of Clinical Pharmacology, 2006;46:945-951
©2006 the American College of Clinical Pharmacology
favorable conditions for wide-scale improvements
in therapeutic practices.
The number and duration of drugs used have been
shown to have a correlation with mortality in the hos-
pital. Hartmann et al3 reported that antibiotic therapy
can be viewed as a surrogate marker for infections and
correlates with hospital mortality in patients staying
for more than 24 hours in a surgical intensive care
unit. Length of stay in the ICU is affected by a number
of factors. To investigate factors that may influence
duration of stay, Bobek et al2 conducted an exploratory
multiple regression analysis using length of stay as
the dependent variable and the following as indepen-
dent variables: Acute Physiology and Chronic Health
Evaluation (APACHE III) scores, gender, age, death,
occurrence of hospital-acquired infections, self-extu-
bation, use of physical restraints, and number of med-
ication classes received. It was revealed that the
number of medication classes was a significant inde-
pendent factor associated with length of stay.
The present study was carried out with the follow-
ing objectives:
1. to evaluate drug utilization patterns in the ICU,
2. to find out the factors influencing length of stay, out-
come of the patient (in relation to drug use pattern),
and cost of drug therapy.
945
 BISWAL ET AL

Table I Demographic and Other Parameters of Patients During an Intensive Care Unit (ICU) Stay
Characteristics Trauma (n = 44) Othersa (n = 40) P Value

Sex (male) 37 29
Age (years) 31.2 ± 18.4 35.8 ± 18.6 .25
30 (18.5-41.8) 35 (20-49.5)
APACHE IIIb 52.5 ± 19.3 64.6 ± 28.4 .03
51 (39.3-64.7) 55.5 (44.2–83.7)
GCSb 7.8 ± 2.4 (n = 40) 7.8 ± 3.1 (n = 36) 1.00
7 (6-10.8) 7.5 (5–11)
Duration of stay (in days) 11.9 ± 7.3 9.4 ± 6.9 .1
10 (7-15) 7 (4–12)
Duration of ventilation (in days) 9 ± 6.7 7 ± 5.2 .13
7 (4-12) 5 (4-7.8)
Duration of arterial linec (in days) 5.2 ± 2.0 (n = 13) 8.7 ± 6.3 (n = 20)
5 (4-7) 5.5 (4-1.8)
Duration of central linec (in days) 9.2 ± 5.1 (n = 33) 8 ± 6.2 (n = 34)
8 (4.5-13) 5 (4-11)
Data are expressed as mean ± SD (top row) and median, interquartile range (bottom row). APACHE III, Acute Physiology and Chronic Health Evaluation;
GCS, Glasgow Coma Scale.
a. Other patients who were admitted for medical or surgical conditions other than trauma.
b. Scores taken at the time of admission to the ICU.
c. Those patients who required either an arterial line or a central line.

MATERIALS AND METHODS
The present study was carried out in the ICU of the
Postgraduate Institute of Medical Education & Research,
India, Chandigarh. The general ICU of our institution
has 10 beds and cares for adult patients of all depart-
ments. All the patients admitted between February
and May 2005 were followed up for their entire dura-
tion of stay. Data were collected from patient records
and patients. The following parameters were evaluated.
• Drug utilization: Drugs used by the patients each day
were entered into a predesigned case record form.
Drugs were classified into different classes and then
individual generic types. Total amount of drugs for
individual patients in each generic type was calcu-
lated. Daily defined dose (DDD) of each drug type
was calculated as the total quantity of drug adminis-
tered divided by the number of patient-days the drug
was given. The proportion of patients taking drugs
from different drug classes as well as individual drug
type was evaluated. Numbers of different drugs pre-
scribed to each patient at the time of admission to
ICU, within 24 hours of the ICU stay, and during the
entire duration of the ICU stay were calculated.
• Cost of drug therapy: Cost of each drug class or indi-
vidual drug type for each patient was calculated by
taking into consideration the average cost of leading
brands of drugs available.
• Disease severity: The severity of the disease of the
patients was evaluated by the APACHE III scoring
system4 and the Glasgow Coma Scale (GCS) at the
time of admission to the ICU.
• Association between ICU deaths and duration of
stay with individual drug class
STATISTICAL ANALYSIS
Data are expressed as mean and standard deviation
(SD) or median and interquartile range (IQR), and
mostly descriptive statistics has been used. The asso-
ciation between numerical data was evaluated by
Pearson’s correlation coefficient, and the association
between numerical and nominal data was evaluated
by logistic regression analysis and calculation of
odds ratios with the 95% confidence interval (CI).
Comparison between trauma and nontrauma patients
regarding demographic and other variables was car-
ried out by an independent sample t test. A P value
less than .05 was considered significant.
RESULTS
During the observational period, of the 84 patients
treated in the ICU, 44 had trauma, whereas the others
were admitted for various medical and surgical ill-
nesses. Patients had head, chest, or abdomen trauma
and fracture of bones or combinations of both, and some
suffered electrocution and drowning. The other patients
had illnesses such as acute pancreatitis, poisoning,
hepatic encephalopathy or failure, postoperative

946 • J Clin Pharmacol 2006;46:945-951

 DRUG UTILIZATION PATTERN IN THE INTENSIVE CARE UNIT
35
30
25
20
15
10
5
0
All drugs Antibiotics
At admission (Concurrent) Ist day (Concurrent)
Total (Cummulative during the entire stay)
Figure 1. Number (mean ± SD) of all drugs and antibiotics used
at various times of the intensive care unit (ICU) stay.
conditions, perforation peritonitis, multiorgan dys-
function syndrome, respiratory failure, status epilepti-
cus, carcinoma, postcardiac arrest conditions, and so
on. We presume that the trauma patients were other-
wise healthy and without any obvious systemic ill-
nesses requiring hospitalization. Table I describes the
demographic and certain other parameters of the ICU
stay. All patients except 1 required ventilatory support.
The prescribed drugs spanned diverse classes;
some were prophylactic, whereas others were thera-
peutic in nature. Out of 162 different drugs, 67 belong
to the World Health Organization’s (WHO’s) essential
drug list. Another 11 were from the WHO comple-
mentary essential drug list. Sixty percent of the drugs
were prescribed as trade names. The number of dif-
ferent drugs for each patient ranged from 2 to 38. On
average, patients received 5.3 (concurrent) different
drugs at the time of admission to the ICU. This
amount rose to 12.9 (concurrent) within 24 hours and
22.2 (cumulative) during the entire stay in the ICU
(Figure 1). Between trauma and nontrauma patients,
there was no significant difference in the number of
drugs used at the time of admission, during the first
24 hours, or throughout the entire stay in the ICU.
Whereas the total number of drugs strongly correlated
with duration of stay in ICU (r = 0.58, P < .001) and
modestly with the disease severity score (ie, APACHE
III at the time of admission to the ICU; r = 0.33, P <
.005), there was little correlation between the number
of drugs at the time of admission to the ICU and dis-
ease severity score, age, or sex of the patient.
PHARMACOEPIDEMIOLOGY
120
100
Proportion (percentage)
80
60
Nutritional supplements
40
DVT prophylaxis
Bronchodilators
Antiepileptics
Antipyretics
Antibiotics
Sedatives
Laxatives
Inotropes
20
Antiulcer
Diuretics
Steroids
Insulin
0
Figure 2. Percentage of patients who received various classes of
drugs during a stay in the intensive care unit (ICU). DVT, deep
vein thrombosis.
Patients were prescribed an average amount of 8.6
liters of different parenteral fluids during the entire
stay in the ICU, of which 1.3 liters were colloids,
although it varied considerably. Amount of fluid
consumption increased with duration of stay (r =
0.49, P < .001), but it was not affected by disease
severity or trauma status of the patients. Colloid use
increased slightly along with disease severity (r =
0.22, P < .001). Patients requiring inotropes used
more fluids (mean difference = 5.5 liters, P = .001)
and colloids (mean difference = 1.8 liters, P < .001).
Within 24 hours of the ICU stay, almost all
patients (97.6%) received antibiotics, in contrast to
61.9% who had received antibiotics at the time of
admission (Table II). Similarly, the number of antibi-
otics also increased significantly (Figure 1). At the
time of admission to the ICU, there was no signifi-
cant difference in the number of antibiotics per
patient irrespective of trauma status, whereas it was
lower in trauma patients during the first 24 hours of
the ICU stay (mean difference = 0.45, P = .02). The
total number of antibiotics during the entire stay in
the ICU increased in both groups, but the difference
in number reduced to nonsignificant levels. Like the
total number of drugs, it had a moderate positive
correlation with duration of stay (r = 0.45, P < .001).
Details of antibiotic choice and its daily defined
doses are shown in Table II.
Figure 2 shows the proportion of patients who
used different classes of drugs. Antibiotics, antiulcer/
antireflux medications, sedatives, and nutritional
supplements and fluids were used in more than 90%
of patients, whereas bronchodilators, antipyretics,
laxatives, and diuretics were used in 50% to 75% of
the patients. Between 35% and 45% of patients used
947
 BISWAL ET AL

Table II Antibiotic Utilization at Different Times of an Intensive Care Unit (ICU) Stay (61.9%
at the Time of Admission, 97.6% Within 24 Hours or During the Entire Stay)
At the Time of
Admission to ICU At the End of the First Day During the Stay in the ICU
(Drug, Proportion of (Drug, Proportion of (Drug, Proportion of Patients
Patients in %) Patients in %) in %), DDD in Grams

Metronidazole (18) Metronidazole (62) Metronidazole (67),

tab 1.52, inj 1.21
Cefotaxime (13) Amikacin (52) Amikacin (57), 0.83
Amoxycillin + Cefotaxime (41) Cefotaxime (40), 4.2
clavulinic acid (12)
Cefepime (8) Ciprofloxacin (18) Ciprofloxacin (38),
tab 1.0, inj 0.5
Ciprofloxacin (8) Cefepime (17) Piperacillin +
tazobactam (20), 13.5
Amikacin (8) Amoxycillin + Cefepime (18), 2.0
clavulinic acid (13)
Ceftriaxone (6) Piperacillin + Amoxycillin + clavulinic
tazobactam (10) acid (13), 2.7
Clindamycin (5) Levofloxacin (8) Ceftazidm (12), 3.0
Levofloxacin (5) Ceftriaxone (6) Ceftriaxone +
sulbactam (11.9), 3.0
Ceftazidm (4) Linezolid (5) Linezolid (11), 1.2
sulbactam (11.9), 3.0
Vancomycin (4)
Proportions of patients who received different antibiotics (10 most common) at different time points irrespective of duration have been shown. tab,
tablet; inj, injection. In the third column, in addition to the proportion of patients who received different antibiotics, daily defined doses (DDD) in
g/d/patient for the total stay have been shown.

steroids, deep vein thrombosis (DVT) prophylaxis,
insulin, antiepileptics, and inotropes.
Table III shows drugs prescribed in individual
classes. Among antiulcer drugs, an almost equal pro-
portion of patients received H2 receptor blockers and
proton pump inhibitors. Similarly, an equal propor-
tion of patients received low–molecular weight
heparins and unfractioned heparin. Morphine was
the first-choice sedative, followed by midazolam
and diazepam. More than 50% of patients were
administered some oral multivitamins, whereas
nearly 15% received parenteral preparations. Of the
patients, 78.8% received oral KCL, and 44% received
oral iron, zinc, and folic acid combination preparations.
Although 88% of patients were on enteral nutrition,
9.5% of patients received parenteral lipids, amino
acids, or both.
Certain classes of drug use were associated with an
adverse outcome on mortality (Table IV). Steroid and
antiepileptic use were not related to increased mor-
tality, whereas insulin and inotrope use signified
adverse prognosis, as evident from the odds ratios.
When 1 inotrope was used, there was no significant
increase in mortality, whereas multiple-inotrope use
increased the odds of adverse outcome. Although
previous studies have reported a correlation between
the number of antibiotics used and the increased risk
of mortality3 as well as number of sedatives used with
duration of stay,2 we did not find a similar association.
Cost of drug therapy varied substantially from
patient to patient (rupees 227-82 064; mean ± SD,
19 725 ± 19 593 rupees; median, 12 998 rupees;
25th-75th percentile, 4740-26 705 rupees; $1 = 43
Indian rupees). Average percentage expenditures on
various drug classes are presented in Figure 3. The cost
of drugs increased with duration of stay (r = 0.54,
P < .001) and number of drugs used (r = 0.49,
P < .001). Among the drug classes, antibiotics influ-
enced drug cost maximally. Number of antibiotics
used strongly correlated with total drug cost (r = 0.52,
P < .001). However, disease severity at the time of
admission had no correlation with drug cost.
DISCUSSION
About 50% of different drugs used in the ICU are
either on the WHO essential drug list or comple-
mentary drug list. This is quite expected, considering

948 • J Clin Pharmacol 2006;46:945-951

 DRUG UTILIZATION PATTERN IN THE INTENSIVE CARE UNIT

Table III Various Drug Classes, Drugs, Proportion of Patients Who Were
Prescribed, and Daily Defined Doses
Name of Drug Proportions DDD (mg) Name of Drug Proportions DDD (mg)

Inotropes Steroids
Dopamine 33.3 552 Dexamethasone 21.4 3.1
Noradrenaline 25 8.4 Hydrocortisone 20.2 213.5
Dobutamine 3.6 540 Methyl prednisolone 9.5 1564
Adrenaline 3.6 10.7 Analgesics and
Isoproterenol 1.2 12 sedatives
Antiulcer, antireflux Morphine 88.1 37.7
Ranitidine 34.5 81 Midazolam 44 79.7
Ranitidine (O) 33.3 254 Diazepam 34.5 16.6
Pantoprazole 32.1 60 Diazepam (O) 20.2 16.3
Pantoprazole (O) 23.8 65 Propofol 14.3 1267
Rabeprazole (O) 6 19.1 Lorazepam 11.9 2.6
Sucralfate (O) 8.3 40.1 mL Antipyretics
Metoclopramide (O) 34.5 20 Paracetamol (O) 39.3 1779
Metoclopramide 31 19 Paracetamol 23.8 1664
Deep vein thrombosis Diuretics
prophylaxis Mannitol 42.9 237 mL
Heparin 23.8 10 402 IU Furosemide 36.9 45.2
Enoxaparin 22.6 56.65 Frusemide (O) 16.7 40.8
Antiepileptics Nutritional
Phenytoin (O) 22.6 297 supplements
Phenytoin 22.6 467 Calcium (O) 7.1 1000
Clobazam (O) 6 34 Vitamin C (O) 35.7 500
Valproate (O) 2.4 1330 Multivitamins (O) 51.2 1U
Phenobarbital (O) 1.2 90 Multivitamins 14.3 1U
Phenobarbital 1.2 120 Iron, zinc, and 44 150 1U
Laxatives folic acid (O) 61.8, 0.5
Lactulose (O) 45.2 19.0 mL Vitamin E (O) 22.6 72.73
Milk of Magnesia (O) 7.1 15.0 mL Protein 17.9 68 g
Bisacodyl (O) 4.8 1U supplements (O)
Suppository 4.8 1U Electrolytes
Phosphate enema 33.3 1U NaHCO3 8.3 315 mEq
Insulin Calcium gluconate 7.1 1326
Regular 39.3 25.1 U KCL (O) 78.8 47 mEq
KCL 6 413 mEq
MgSO4 20.2 6421
Daily defined doses have been expressed in milligrams (mg) unless mentioned otherwise. g, gram; mL, milliliter; mEq, milliequivalents; IU, international
units; U, units. Number of tablets or enema has been mentioned as units. O, oral preparations.

the severity of illnesses of the patients in the ICU. A
relatively higher proportion of drugs (60%) was pre-
scribed as trade names. As there are frequent newspa-
per reports or media hype about the distribution of
imitation drugs in India, some physicians working in
our ICU feel that prescribing trade names may ensure
quality. However, price differences between brand-
name and generic drugs are not significant in India
due to a lack of a product patent regime before 2005.
In a setup such as the ICU, certain drugs are rou-
tinely used prophylactically (eg, antibiotics, antiulcer
agents, antireflux agents, sedatives, nutritional sup-
plements, DVT prophylaxis, etc) to prevent compli-
cations, whereas others are used therapeutically
(eg, inotropes, steroids, laxatives, antibiotics, insulin,
antipyretics, etc) as required to aid recovery. For
these reasons, the number of drugs increased more
than 2-fold within 24 hours of the ICU stay and
increased steadily, with a strong positive correlation
(r = 0.58) with duration of stay. Aggressive prophy-
lactic and therapeutic measures may be required for
more critically ill patients if they do not improve

PHARMACOEPIDEMIOLOGY 949
 BISWAL ET AL
Table IV Mortality Associated With Various
Classes of Drugs
95% Confidence
Name of Drug Class Odds Ratio Interval
Inotropes 8.4 2.9-24.8
Number of inotropes
1 1.7 0.3-9.6
2 13.4 3.5-51
3 26.9 2.6-276.2
Insulin 3.4 1.27-9.3
Inotropes + insulin 7.1 2.3-22
Steroids 2.0 0.8-5.3
Antiepileptics 0.5 0.2-1.5
subsequently according to expectation. Similarly, the
number of drugs had a positive correlation (r = 0.33) to
APACHE III scores at the time of admission to the ICU.
The number of different drugs that were prescribed
within 24 hours of the ICU stay to a patient did not
depend on age, sex, trauma status, or severity of illness.
This implies therapeutic intervention in accordance to
some fixed protocol. Comparisons were made between
trauma and nontrauma patients, assuming that the for-
mer ones are otherwise healthy and may not be taking
any medication with which comparisons can be made.
Antibiotic use policy is a very controversial issue.
It varies from hospital to hospital and among different
departments of the same hospital. Patients treated in
ICUs are 5 to 10 times more prone to develop nosoco-
mial infections.5 Pneumonia is known to develop
very commonly in the ICU setup, and ventilator-
associated pneumonia (VAP) is associated with pro-
longed mechanical ventilation, increased ICU length
of stay, and increased mortality.6-10 In our ICU, any
patient arriving in an intubated condition is usually
put on antibiotics to prevent the development of noso-
comial infections. In the absence of any signs of
infection, fever, or increase in blood counts, antibi-
otics are stopped after 7 to 10 days. Once fever per-
sists or any signs of infection do not resolve or appear
beyond 14 days of antibiotic use, newer antibiotics
are added or previous ones are changed because resis-
tance is suspected. Moreover, antibiotics are added
or modified according to routine microbiological
culture and sensitivity reports. Those patients who
are already on antibiotics while being admitted to
the ICU are continued with the same or modified
antibiotics. Almost all the patients (83 out of 84
patients) already had been intubated when they
were admitted to the ICU. This possibly explains
most of the increased antibiotic utilization findings in
950 • J Clin Pharmacol 2006;46:945-951
Analgesics & Fluids (12%)
Sedatives (9%) 6.7% 5.1%
Steroids (2%) 3.6%
DVT prophylaxis (2%)
9.8% Others (32%) 14.4%
Inotropes (3%) Antiepileptics (3%) 0.3%
5.9% Antiulcers (6%) 0.9%
Nutritional supplements (7%) 0.9%
Bronchodilators (5%) 0.8%
Insulin (2%) 0.3%
Antibiotics (17%)
51.3%
Figure 3. Average proportion of the number of various drugs
and their cost (in percentages). DVT, deep vein thrombosis.
the present study. Although the number of antibiotics
used was less for trauma patients within 24 hours of
the ICU stay compared to other patients, there was no
difference at the end of the entire stay. This suggests
that there are some ICU-specific factors, such as con-
tracting nosocomial infection in the ICU, the manifes-
tation of infection contracted in the previous ward,
and so on. Further studies are warranted to explore
any specific factors responsible for this and the clini-
cal relevance of the increased number of antibiotics
used during the course of treatment in trauma patients.
Previous studies have shown an association of
prognosis as well as length of stay with some groups
of drug use and demographic factors.3,11,12 This may
signify prognostic indications rather than a causality
association. Out of various classes of drugs used, the
requirement of inotrope and insulin was associated
with a higher probability of in-ICU deaths. When the
number of inotropes used was further analyzed, it
became evident that multiple-inotrope use was asso-
ciated with a higher probability of death, whereas
single-inotrope use did not increase it to statistically
significant levels. A similar finding was also demon-
strated by Bernieh et al11 in acute renal failure patients
and by Sudarsanam et al13 in ICU patients. There can
be several reasons inotrope use may be associated
with increased mortality in ICU patients. Inotropes
that are used to increase oxygen delivery to the vital
organs14 also increase the oxygen requirement of the
tissue (eg, epinephrine increases oxygen consump-
tion by 20% to 30% after conventional doses15). This
increase is associated with a fall in O2 extraction at
the tissue level.16 It is conceivable that aggressive use
of inotropes limits the delivery of oxygen by exacer-
bating the misdistribution of blood flow within the
microcirculation, resulting in impaired perfusion of
vital organs such as the kidney and gastrointestinal
 DRUG UTILIZATION PATTERN IN THE INTENSIVE CARE UNIT
tract, thereby leading to a higher incidence of multi-
organ dysfunction in critically ill patients.17 Again,
patients requiring a lower dose of inotropes may
have a larger physiologic reserve and less severe ill-
ness and, consequently, a better prognosis.3 It is dif-
ficult to comment on the association between the
insulin requirement and increased mortality at this
stage. As it was not possible to control for various
factors either in the study design or in the statistical
analysis, further well-designed studies are required
to establish whether these associations are mere
indicators of patient severity or if any causality is
there. However, in a recent study, Van den Berghe et
al18 demonstrated that intensive insulin therapy in
the medical ICU reduces morbidity without affecting
mortality.
Although previous studies have demonstrated a
correlation between the number of antibiotics used
with ICU deaths3 and the number of sedatives used
with duration of stay,2 we did not find similar results
in our study.
The cost of drug therapy influences the hospital
pharmacy profoundly.1 In our study, for an individ-
ual patient, it varied considerably depending on dura-
tion of stay and the number of drugs prescribed.
Among the drug classes, antibiotics accounted for a
significant fraction of drug cost, although there can
be significant variation. Most of the time, antibiotics
were used prophylactically, so further studies can be
planned to evaluate the scope of refining antibiotic
prescription and thereby cost containment. Our study
can serve as a guide for future interhospital or insti-
tutional comparisons.
CONCLUSION
There is a tremendous impact of antibiotic use on
the cost of therapy in ICU. The requirement of cer-
tain drugs such as insulin and inotropes is of prog-
nostic significance.
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