Analysis of Antimicrobial Utilization Pattern in Neonatal Intensive Care Unit: A Prospective Observational Study

Aim: To analyze patterns of antimicrobial utilization and associated outcomes among neonates admitted to the neonatal intensive care unit (NICU) of a tertiary hospital in Madikeri, Karnataka, India. Materials and Methods: A prospective observational study was conducted over 18 months (January 2021–June 2023) in the NICU of Kodagu Institute of Medical Sciences. Data on demographics, diagnoses, antimicrobial prescriptions, dosing patterns, and outcomes were recorded. Rationality was assessed using the World Health Organization (WHO) prescribing indicators. Results: Of 1,072 neonates admitted, most received empirical antimicrobial therapy. Jaundice (40%) was the leading diagnosis, followed by respiratory distress syndrome (15%) and sepsis (12%). Cephalosporins (45%) and aminoglycosides (30%) were the most frequently prescribed classes, with amikacin–cefotaxime the predominant regimen. Over 80% of prescriptions were empirical, with limited culture-based modification. Adverse drug reactions occurred in 3% of neonates and were mild. Conclusion: Empirical, broad-spectrum antimicrobial use predominated, highlighting the need for enhanced culture-based therapy and stewardship interventions to limit resistance.