RESUMO
Objective: To study whether introduction of an ‘antimicrobial justification form’ deters clinicians from prescribing restricted antimicrobials and results in de-escalation of these antimicrobials. Methods: Clinicians were asked to fill a justification form if prescribing an antimicrobial from the pre-identified restricted group. Antimicrobial usage pattern over next year was compared with that in the one year preceding the introduction of justification form. Results: Significant overall decrease in antimicrobial usage (40.5% vs 34.6%) was noted in the post-intervention group along with a significant increase in the de-escalation of antibiotics. Conclusion: Introduction of a justification form before prescribing antimicrobials or at the time of deferring de-escalation can be useful in restricting usage of antimicrobials
RESUMO
Objective: To observe the safety and efficacy of Colistimethate sodium in children infected with gram-negative bacteria, susceptible only to colistimethate sodium. Methods: This prospective observational study done over 2 years observed children who received colistin for >48 h, for renal failure as defined by p-RIFLE criteria. Results: Out of 68 children, 52 (76.5%) survived. There were three children with evidence of acute kidney injury and none had neurotoxicity. Serum creatinine significantly decreased at 48 h and at end of treatment, from that at beginning of therapy (P=0.007). Conclusion: Colistimethate sodium is effective against carbapenem-resistant Gram-negative bacteria, and is safe in children.