Antibiotic costs and prescribing patterns in a recently commissioned Liverpool teaching hospital. Part I: Antimicrobial therapy.

All antibiotics prescribed in a major teaching hospital were prospectively surveyed during 31 consecutive days. Of 2350 patients admitted during that period, 577 (24.6%) received antibiotics, 238 (10.1%) for prophylaxis and 417 (17.7%) for treatment. A total of 483 infections occurred in the treated patients, mainly in the chest (33.9%) and urinary tract (27.7%). Two hundred and forty-four infections (50.5%) were community-acquired and the remaining 239 hospital-acquired infections occurred in 8% of patients admitted. The cost of treating nosocomial sepsis was 4453 pounds (48% of the antibiotic expenditure for treatment). The average cost of treatment per patient varied considerably between hospital specialties; one-third of therapeutic antibiotic expenditure was consumed by haematological patients. Thirty-one antimicrobials alone or in 45 different combinations were issued; ampicillins were the most frequently prescribed antibiotics (31%), followed by co-trimoxazole (14%) and trimethoprim (8%). The patterns of antibiotic usage are discussed and inappropriate prescriptions examined.

Antibiotic costs and prescribing patterns in a recently commissioned Liverpool teaching hospital. Part II: Antimicrobial chemoprophylaxis.

All antibiotics prescribed for prophylaxis in a major teaching hospital were prospectively surveyed during 31 consecutive days. Of 2350 patients admitted during that period, 238 (10.1%) received antibiotics for prophylaxis. A total of 1238 operations were performed during the period of study, of which 201 (16.2%) were covered with antibiotics, at a cost of 3472 pounds. The use of prophylaxis increased according to the risk of peri-operative wound contamination, from 15.8% in Class I to 52.4% in Class III operations. The average cost of chemoprophylaxis also increased correspondingly. A further 40 regimens were issued for non-surgical prophylaxis at a cost of 258 pounds. Twenty antibiotics were prescribed either alone or in 37 different combinations for surgical prophylaxis, the most frequent being cephradine (22%), metronidazole (17%), penicillin (12%), and tobramycin (11%). The mean duration of antibiotic administration for all surgical procedures was 6.1 days.

Bilateral salmonella salpingo-oophoritis.

A previously healthy nulliparous caucasian female presented with lower abdominal pain and a history of diarrhoea and vomiting for 2 weeks. Repeated stool examinations and blood culture were negative. A lump in the lower abdomen became more apparent over the next 2 weeks and a subsequent laparotomy revealed bilateral tubo-ovarian abscess formation. One ovary which was endometriotic and both the tubes were excised and the pus yielded a heavy growth of Salmonella stanley.

Fatal varicella in a healthy young adult.

A healthy adult presented with severe neurological disturbance 4 d after developing chicken-pox. Although pneumonic and renal problems were also present the neurological state dominated the clinical picture. After the patient's sudden death an autopsy revealed that renal and cerebral problems were secondary to myocardial involvement. This was of an unusual type for varicella with features of dilated cardiomyopathy resembling that previously related to Coxsackie infections. We conclude that cardiac problems in this patient produced anoxic brain damage and subsequently death.