Utilization of Restricted Antibiotics in a University Hospital in Thailand
Sasima Kusuma Na AyuthyaOraphan MatangkasombutSayomporn SirinavinBoonmee SathapatayavongsKumthorn Malathum
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Antibiotic resistance, a major negative consequence of antibiotic overuse, is one of the mainstay problems worldwide. Various means have been used to control antibiotic usage including the use of an antibiotic order form (AOF), restricted antibiotic formularies and provision of educational information. The present study was designed to evaluate the use of antimicrobial in a 1,000-bed university hospital. Antimicrobial agents which are likely to be abused namely ceftazidime, cefepime, cefoperazone/sulbactam, imipenem/cilastatin, meropenem, ciprofloxacin, netilmicin, vancomycin, azithromycin and clarithromycin were selected for evaluation. A simple AOF with educational information was used as a mean to follow-up the treatment. The investigator collected data from the filled AOF and the patient's charts, Department of Internal Medicine from June - November 2000, and all relevant data were assessed. The appropriateness of antibiotic use was assessed according to the criteria specified in the AOF showed that 74% of these antibiotics were prescribed appropriately. This may prove the effectiveness of the system used in the present study. However, 348 of the 430 prescriptions (80.9%) were prescribed empirically at the initial stage for treatment of nosocomial infections in patients with serious conditions like pneumonia, sepsis and febrile neutropenia. Drugs that were frequently used empirically were ceftazidime (37.9%), imipenem/cilastatin or meropenem (19 .3% ), and cefoperazone/sulbactam ( 12.1 % ) respectively. Ceftazidime and imipenem/cilastatin or meropenem were also frequently used inappropriately among 111 prescriptions that were classified as an inappropriate prescribing. The most common misuses were prescriptions of the drug that did not follow the specified indications (70 prescriptions), no dosage adjustment in patients with renal impairment (39 prescriptions), improper dose (12 prescriptions) and improper dosing interval (9 prescriptions). The results suggested overuse of certain antibiotics remain to be an unsolved problem. A better monitoring and strictly control the use of the problematic antibiotics, i.e. ceftazidime, imipenem/cilastatin or meropenem and vancomycin are essential to promote the rational drug use as well as to reduce drug resistance.Keywords:
Cefepime
Formulary
Cilastatin
Cefoperazone
Sulbactam
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Tazobactam
Prior authorization
Piperacillin/tazobactam
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OBJECTIVE: To analyze the use of antibiotics in the patients of our hospital to provide references for clinical rational use of antibiotics.METHODS: 4 216 outpatient prescriptions and 420 medical records in the first half year of 2011 were sampled randomly for statistical analysis of the antibiotic use.RESULTS: The rate of antibiotic use in outpatients was 34.1%(1 437/4 216);in the inpatients,the rate of antibiotic use was 70.0%(294/420),with the rate of rational drug use of 68.1%(286/420) and the rate of specimen test of 53.3%(224/420).The antibiotics ranked among the last 5 places in respect of DDC were sparfloxacin,erythromycin,gatifloxacin,clarithromycin and ampicillin/probenecid,with all administered orally.The top five antibiotics in terms of DDDs for inpatients were cefoperazone/sulbactam,cefalotin,mezlocillin,cephazolin and cefuroxime.The top 4 antibiotics ranked by DUI in descending order were ceftezole clindamycin mezlocillin levofloxacin1.The total antibiotic use density which stood at 53.3 DDD was significantly higher than the specified value of 40 DDD.CONCLUSION: The use of antibiotics in our hospital was basically rational yet far from perfect,thus it is urgent to tighten monitoring the use of antibiotics to promote clinical rational use antibiotics.
Mezlocillin
Cefoperazone
Sulbactam
Cefuroxime
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Antibiotic resistance, a major negative consequence of antibiotic overuse, is an important problem worldwide. Various means have been used to control antibiotic usage including the use of an antibiotic order form (AOF), restricted antibiotic formularies and provision of educational information. The present study was designed to evaluate the use of antimicrobials in a 1,000-bed university hospital. Antimicrobial agents, likely to be abused namely ceftazidime, cefepime, cefoperazone/sulbactam, imipenem/cilastatin, meropenem, ciprofloxacin, netilmicin, vancomycin, azithromycin and clarithromycin, were selected for evaluation. A simple AOF with educational information was used as a mean to follow up the treatment. The investigator collected data from the filled AOF and the patient's charts of the Department of Internal Medicine from June to November 2000; all relevant data were assessed. The appropriateness of antibiotic use, assessed according to the criteria specified in the AOF, showed that 74% of these antibiotics were prescribed appropriately; this may prove the effectiveness of the system used in the present study. However, 348 of the 430 prescriptions (80.9%) were prescribed empirically at the initial stage for treatment of nosocomial infections in patients with serious conditions like pneumonia, sepsis and febrile neutropenia. Drugs that were frequently used empirically were ceftazidime (37.9%), imipenem/cilastatin or meropenem (19.3%), and cefoperazone/sulbactam (12.1%) respectively. Ceftazidime and imipenem/cilastatin or meropenem were also frequently used inappropriately among 111 prescriptions that were classified as an inappropriate prescribing. The most common misuses were prescriptions of the drug that did not follow the specified indications (70 prescriptions), no dosage adjustment in patients with renal impairment (39 prescriptions), improper dose (12 prescriptions) and improper dosing interval (9 prescriptions). The results suggested overuse of certain antibiotics remain to be an unsolved problem. Better monitoring and strict controlled use of the problematic antibiotics, ie ceftazidime, imipenem/cilastatin or meropenem and vancomycin are essential to promote rational drug use as well as to reduce the frequency of drug resistance.
Cefepime
Cilastatin
Formulary
Cefoperazone
Sulbactam
Cite
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Increasing trend in the development of antibiotic resistance is one the major concerns of health care systems throughout the world. Several factors are responsible of the emergence of this problem of which frequent inappropriate uses of antimicrobial agents plays an important role. Therefore, in the study we aimed to assess the appropriateness of the usage of meropenem, a broad-spectrum antibiotic, in a teaching affiliated hospital.This study is an observational prospective research on drug utilization. All patients admitted to Masih Daneshvari hospital that had received meropenem during Jun to July 2011 were enrolled in the study. To evaluate the appropriate use of meropenem, an institutional standard guideline was designed by pharmacy and therapeutic committee using evidence-based guidelines. Prescriptions were considered appropriate if they were compliant with the guideline. The total number of meropenem vials used during this period was 2153 vials. Most prescriptions started empirically (85.9%). Of these, 16.9% of prescriptions continued according to lab results whereas 69% of meropenem courses remained empirical. Our results showed that meropenem was started appropriately in 64.8% of patients whereas just 74.3% of patients received the drug for an adequate duration.In conclusion, our study and several other surveys detected various areas of inappropriate use of broad-spectrum antiobiotics such as meropenem. With regard to the important role of these drugs in the treatment of serious nosocomial infections, a combination of both restrictive and educational measures appears to be necessary to improve rational antibiotic usage as well as to decrease in the frequency of antibiotic resistant.
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Objective: To evaluate the use of piperacillin-tazobactam, imipenem and meropenem by determining if the indication, the dosage and the administration times were adequate according to the current guidelines and to review if the prescription was made accordingly to the criteria established in the hospital.
Method: Six month retrospective observational study has been done in a secondlevel university hospital. Daily, treatment and clinical data were recorded. At hospital discharge the appropriateness of prescriptions was assessed by members of the Committee of Infectious diseases.
Results: 214 prescriptions were studied and the 57.5% of them were appropriate: 57.8% of piperacillin-tazobactam (No. = 118), 59.3% of imipenem (No. = 81) and 47.4% of meropenem (No. = 19). The reasons of inadequacy were: 57.1% availability of another drug of choice, 22% for incorrect dose, 16.5% for wrong treatment duration and 4.4% for inappropriate frequency. Pneumology was the department with highest percentage of appropriateness. As indication, was febrile neutropenia.
Conclusion: Outcomes show that approximately 60% of the prescriptions were appropriate. The most common reason for inappropriateness was the availability of another alternative of choice. Measures to increase the quality of prescriptions are: to review prescription protocols, to spread the outcomes to health professionals
and to promote rational use of antimicrobials in empiric treatment. After implantation it will be assessed anew to evaluate impact of measures
Piperacillin/tazobactam
Tazobactam
Empiric therapy
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Background: Antibiotics can be life saving if they are used correctly, and can have unwanted side effects specially resistance with incorrect use. Unfortunately in fear of no response, physicians use broad spectrum antibiotics meticulously. In this Drug Utilization Evaluation (DUE), improper use of Vancomycin and five broad-spectrum antibiotics are studied to find faults and solution for this problem. Methods: This descriptive cross-sectional study performed during the March of 2012 to March of 2013.DUE of Imipenem, Meropenem, Piperacillin-Tazobactam, Cefepime, Ciprofloxacin and Vancomycin was done in 6 wards of Imam Hossein Hospital in Tehran. Demographic, clinical, laboratory, imaging and treatment data were looked for in medical records of 686 patients. Evaluation was done by three infectious disease specialist based on reference text book of Mandell’s Principles and Practice of Infectious Diseases 2010 and IDSA Guidelines. Results: This study showed 38.5% of prescriptions were correct and the remained 61.5% were incorrect with different faults predominantly incorrect overuse in 51.1%.Ciprofloxacin was the most common incorrect used drug in 74.8% cases and Piperacillin-Tazobactam with 48.7% cases had the least common incorrect use. There was no fault in prescription of antibiotics observing age and sex (pregnancy, breast feeding) factors. Conclusions: Our results reveal a significant high level of the inappropriate use of Antibiotics mostly as overuse and empirically without culture results. It is needed to establish continuing medical education (CME) courses and a locally conformable guideline of antibiotic use based on antibiogram results.
Cefepime
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Tazobactam
Piperacillin/tazobactam
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Antibiotics are most commonly prescribed drugs in tertiary care hospitals; more than 30% of the hospitalised patients were treated with antibiotics. Rational use of antibiotics is very important to ensure the optimum treatment outcomes and to limit the emergence of bacterial resistance. Present study is a hospital based cross-sectional study carried out for a period of three months in different clinical departments of a tertiary care hospital to find out the antibiotics prescribing pattern. Out of total 551 evaluated prescriptions, an antibiotic was prescribed in 45.5% cases. The most commonly prescribed antibiotics were Moxifloxacin 19.5%, Metronidazole 10.4% and Amoxicillin+Cloxacillin 10.2%, broad spectrum antibiotics usage was higher & 87.7% of the antibiotics were prescribed by brand names. The appropriate use of antibiotic is a greatest need of the current situation all over the world. The rising antibiotic resistance is a global problem which is directly related with the irrational prescription of antibiotics.
Tertiary care
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Antibiotics are one of the most commonly prescribed drugs today. Rational use of antibiotics is therefore extremely important as their injudicious use can adversely affect the patient. Drug Utilization Evaluation (DUE) is a system of ongoing systematic criteria based evaluation of drug that will help to ensure that medicines are used appropriately. It is drug/disease specific and can be structured so that it will assess the actual process of prescribing, dispensing, or administration of drug. The retrospective study was conducted At Pk Das Institute of Medical Sciences, Palakkad, Kerala for a duration of 6 months (February 2017 - January 2018). A source of data includes Patient case sheets &medication charts, nursing charts, culture & sensitivity reports. The inclusion criterion includes Patients aged between 18- 80 year, prescribed with oral and parenteral antibiotics. . On analyzing the gender, male gender (n= 111, 55.5%) were higher in numbers as compared to female counterparts (n=89, 44.5%). In our study the majority of the patients prescribed with antibiotics were with the clinical assessment of COPD (n=39, 19.5%), UTI (n=37, 18.5%) and LRTI (n=28, 14%), Bronchial asthma (n=19, 9.5%) respectively. On analyzing the data based on antibiotic sensitivity test, antibiotic test were performed and followed in (n=64,32%)prescriptions and in (n=47,23.5%)prescriptions were test is not followed respectively. In (n=89,44.5%) prescriptions, antibiotic sensitivity test is not performed. On analysis of antibiotics prescribed, the most commonly prescribed antibiotics were cephalosporins, of these ceftriaxone was highly prescribed of all (n=95). The high percentage of antibiotic prescriptions may indicate a high probability of irrational use. This study also point out irrational use of antibiotics are more leading to resistance, misuse and serious problems. So certain strategies should be put forward to strengthen rational use of antibiotics.
Keywords: Antibiotics, Antibiotic Susceptibility Test, Irrational use, Resistance
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The appropriate use of broad-spectrum antibiotics, including appropriate de-escalation, is essential to reduce the emergence of antibiotic resistance. In surgical floors antibiotics are prescribed for prophylaxis (mostly, single dose), empirical treatment (started if infection is suspected till bacteria are identified with its sensitivity to antibiotics), or treatment of well-defined infection of previously isolated bacteria with its sensitivity to antibiotics. In this study, we aimed to evaluate the use of broad-spectrum antibiotics based on requests for cultures and de-escalation based on sensitivity results of culture tests at tertiary care hospital.A retrospective cohort study was conducted to evaluate the utilization of broad-spectrum antibiotics on surgical floors at a tertiary care center in Jeddah, Saudi Arabia. Patients who are admitted to surgical floors were included if they received any of three broad-spectrum antibiotics (piperacillin-tazobactam, imipenem-cilastatin or meropenem) from 1 June 2014 to 31 August 2014. Data were collected on whether culture and sensitivity test requests were made within 24h of starting antibiotics, the duration of antibiotic therapy and the number of days to de-escalation after receiving culture and sensitivity results.Of the 163 patients who received broad-spectrum antibiotics, culture tests were requested in 112. Before receiving culture results, one patient was discharged and one died. The results of culture tests justified continuation of broad-spectrum antibiotics in only 22 patients, whereas 24 showed no microbial growth in any culture. De-escalation was delayed >24h after culture results became available in 33 out of 64 eligible patients. On the other hand, 51 patients continued receiving broad spectrum antibiotics without any culture test during the whole treatment course.The use of broad-spectrum antibiotics in surgical floors at a tertiary care hospital in Saudi Arabia was largely unjustified by culture-test result. Interventions are needed to enforce culture and sensitivity test requests within 24h of starting the broad spectrum antibiotics therapy with further follow up to ensure appropriate de-escalation and discontinuation whenever indicated.
Piperacillin/tazobactam
Tertiary care
Cilastatin
Tazobactam
Imipenem/cilastatin
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Monitoring of antibiotic drug prescribing is of growing concern due to resistance, adverse reactions and cost. Thus, strict antibiotic policies are warranted. Prior to their implementation, detailed knowledge of antibiotic prescribing patterns is required. In this prospective, pilot study the utilization of antibiotics at the Pediatric Clinic, University Hospital Center Rijeka, Croatia has been analyzed. During a period from 8 January-15 February, 2003, patient charts were reviewed with regard to antibiotic prescription. Antibiotics were prescribed to 88 patients. In 72% of the patients antibiotics were given empirically, and only 20% had proven bacterial infection. More than one antibiotic was prescribed to 15%, and it was changed in 42% of the patients. In total, 150 antibiotic courses were prescribed. Restricted antimicrobials were given in 67% of the courses. Third generation cephalosporins were most commonly prescribed (48% of courses). Ceftriaxone was the single most prescribed drug (29%). Since it is not recommended to use a combination of drugs or a restricted antimicrobial as a first choice in empiric treatment, further diagnose-linked analysis is necessary. It also needs to be assessed whether the reason for such an extensive number of switches in antibiotic agents was a reflection of treatment failure.
Drug Utilization Review
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