Drug utilization evaluation of imipenem and intravenous ciprofloxacin in a teaching hospital

Drug Utilization Evaluation [DUE] studies are designed to assess drug usage appropriateness. We aim to evaluate the drug utilization of intravenous ciprofloxacin and imipenem, two of the broad spectrum antibiotics that consume a significant proportion of our hospitals' outlay, in different wards of a teaching hospital in Zabol. During a 5 months period [December 2010 to May 2011], 263 patients who received imipenem or intravenous ciprofloxacin were assigned to this study. Retrospective review of patient's records was carried out. Data were converted to Defined Daily Dose [DDD] and the ratio of prescribed daily dose per DDD was calculated. Among these records, 100 patients received either imipenem or ciprofloxacin. The ratio of prescribed daily dose to DDD was 1.5 for both antibiotics. Almost all patients received empiric therapy in both groups. Only 13 patients [26%] in ciprofloxacin group and 4 patients [8%] in imipenem group received their antibiotics consistent with American Hospital Formulary System [AHFS] mentioned indication. Baseline Blood Urea Nitrogen [BUN] and serum Creatinine were ordered for only 37 patients [74%] in both groups with 15 abnormal results but dose adjustment performed just in one case with decreased renal function. In conclusion, the majority of courses with both drugs were empirically selected and continued and required lab tests for drug monitoring and dose adjustments were not performed in most cases. Educational interventions, developing a local formulary and a strict antibiotic prescribing policy for example by prior approval by an infectious disease consultant can help significantly to overcome these problems

Compliance with antimicrobial therapy: evaluating the related factors

Uncontrolled and irrational use of antibiotics increases the rate of antimicrobial resistance and treatment failure. Compliance with antibiotics is an important indicator to show how patients use their prescribed drugs and it can explain the relationship between drug administration and treatment outcome that needs to be monitored and promoted. We decided to evaluate compliance to antimicrobial drugs in this study. In a cross-sectional study, 100 patients referring to 4 different specialists' offices were enrolled. The rate and type of non prescribed antibiotic administration were evaluated using predesigned questionnaires. The data were analyzed by SPSS 17.0 software using descriptive statistics and chi-square test for categorical data. Our results showed that 62.4% of the study population had poor compliance and 37.6% had good compliance with their prescribed regimen. [Feeling better] and [getting worse] on prescribed regimen were major reasons for drug discontinuation. About 70% of our study population get non prescribed antibiotic from pharmacies at least once a year. Most of the requested antibiotics were not first line options. Level of education was the only factor significantly related to the rate of patient compliance. This study shows the high rate of non prescribed antibiotic administration and low rate of compliance among the study population that emerge the need for particular patient education and putting restrictive rules to bound non-prescribed and unsupervised antibiotic marketing

Management of community acquired pneumonia in a teaching hospital: the role of established guidelines

In spite of established guidelines developed by the American Thoracic Society [ATS], Infectious Disease Society of America [IDSA] and Centers for Disease Control [CDC], there is no consensus among physicians regarding hospitalization and choice of antibiotics for management of community-acquired pneumonia [CAP]. This study was conducted to determine the percentage of patients appropriately assessed for admittance and the antibiotic treatment selections that were in accordance with the established guideline criteria. This retrospective chart review study was conducted at the National Research Institute of Tuberculosis and Lung Disease [NRITLD], Masih Daneshvari Hospital during 2005-2006. Patients with a definite diagnosis of CAP were selected and entered the study. The previous IDSA, ATS and CDC guidelines and the more recent IDSA/ATS CAP guidelines were all used to evaluate the management of patients admitted with CAP. Patients were excluded if information was not sufficient. A total of 31 patients were reviewed. Of the 31 patients included in the study, 24 [77%] could have been treated with outpatient regimens. Six of 31 cases [19%] had been treated with regimens consistent with all three [IDSA, ATS, and CDC] guidelines. Twelve of 31 cases [39%] had corresponded to the previous treatment recommendations from ATS. The management of the remaining 13 patients [42%] had not corresponded to any of the mentioned guidelines. When compared to the recently published joint guidelines of ATS/IDSA, 12 of 31 cases [39%] had appropriately corresponded to the treatment recommendations. According to this study only one fifth of the cases reviewed could have been treated on an inpatient basis. Considering the standard guidelines 42% of the patients did not follow the recommendations from evidence-based guidelines. The enforcement of guideline usage through education and surveillance in university hospital settings may be required. We suggest the use of evidence-based medicine in the treatment of CAP