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.