Effect of a selective restriction policy on antibiotic expenditure and use: an institutional model.

Strictly enforced antibiotic formulary restriction in combination with formulation of agreed guidelines for antibiotic use in common infection problems such as septicemia, febrile neutropenia, urinary tract infection, biliary sepsis, liver abscess, peritonitis, nosocomial pneumonia, soft tissue infection and purulent meningitis, generated a combined savings of 307,748.5 bahts or 13.5 per cent cost reduction over a 6 month period, and improved quality of use, appropriate 54.8 vs 67.5 per cent, statistically significance (P less than 0.002). Although this saving was offset in part by increased spending of unrestricted antibiotics, such as Penicillin and Gentamicin, an overall cost saving remained. In the months during the restrictions, no significant changes occurred regarding patients response and mortality. However, after the onset of the controls, it was revealed that antibiotics were more appropriately used afterwards. This study has shown, most importantly, that savings were achieved with no negative effect on good patient care. Moreover, the antibiotic use control was operationally successful, most house-staff and attending physicians, not only antibiotic evaluating team, have accepted the program in a very positive way. Overall, this program successfully achieved its initial goal, cost saving without compromising good medical practice. We are now continuing our program and also trying to modify so that it will be useful to all departments in the hospital.

A study on the effectiveness of low-dose liquid antacid in the treatment of duodenal ulcer.

Eighty Thai patients aged 15 to 60 with endoscopic diagnosis of a single duodenal ulcer 5-20 mm. in diameter were randomized into two treatment groups. Group-A patients received hospital - made liquid aluminium – magnesium hydroxide antacid q.i.d. (30 ml. one hour after each meal and at bedtime acid neutralizing capacity 240 mEq/day). Group-B patients received a liquid placebo of similar appearance taken in the same manner. All patients were allowed additional antacid tablets as necessary for relief of ulcer symptoms. Repeat endoscopy was made after 4 weeks of treatment. Ten patients in group A and group B defaulted. The ulcer healing rates in those completing the study were 73.3 and 52.0 percent in group A and group B respectively. The study illustrates that low-dose liquid antacid taken four times daily for four weeks can be associated with duodenal ulcer healing in over two-thirds of cases, although the statistical significance over that of the placebo was not clearly demonstrated in this study with small numbers of cases. It also shows that the four-week placebo healing rate in Thai patients with duodenal ulcer can be as much as fifty percent or greater. Overall, however, patients’ compliance with a liquid medication is below expectation.

Chronic diarrhoea: a prospective study in Thai patients at Chulalongkorn University Hospital, Bangkok.

Fifty-five Thai patients with chronic diarrhoea were prospectively studied to find out the underlying causes. The aetiology was identified in 38.2%, uncertain in 29.1%, and unknown in 32.7% of the patients. In the group with a definitive aetiologic diagnosis, parasitic and infective causes were commoner than non-infective causes. Amoebiasis and giardiasis were more frequent than expected, such that empirical therapeutic trial with an antiprotozoal may be justified if initial routine investigations fail to uncover the cause of the diarrhoea. No significant clinical features were noted between the infective and the non-infective groups. Overall, repeated stool microscopy using the concentration technique was the most useful single investigation in approaching the chronic diarrhoea problem.

Histologic and cytologic study of multiple endoscopic biopsy of gastric ulcer.

A prospective study was carried out on 50 patients with an endoscopicaly proven gastric ulcer. In each patient, multiple endoscopic biopsy specimens were taken for histologic and examinations. In 44 group-A patients with endoscopicaly benign gastric ulcers, both histologic and cytologic examinations failed to discover an overlooked malignant ulcer. This did not imply, however, that both methods were useless in this respect, as the number of patients studied was not very large. In 6 group-B patients in whom a malignant gastric ulcer was evident of otherwise suspected endoscopicaly, both histologic and cytologic examinations did not appear to offer any extra benefit over that of the histologic examination alone. A false-positive reading for malignancy was encountered with the cytologic interpretation in 1 patient of groups B. The authors thus consider that for most endoscopic units in Thailand, multiple endoscopic biopsy sampling for a histologic study with or without a cytlogic study may be reserved only for those gastric ulcer cases in which there is an endoscopic suspicion of an underlying malignancy. The cytologic examination may be implemented only if such facility is readily available. Finally, the “touch-smear” technique for collecting a cytologic specimen would be a convenient and reliable method to be employed.