Continuation of proton pump inhibitors from hospital to community.

OBJECTIVES: To evaluate the appropriateness of initiation of proton pump inhibitor (PPI) treatment in hospital, the quality of discharge information, and any association with continued treatment in the community. METHOD: Survey of all inpatients newly initiated on a PPI in June-August 2003. Assessment of appropriateness of therapy and completeness of discharge information; assessment of continuation of PPI therapy in the community after 6 months. RESULTS: Thirty-five of 58 patients (60%) were considered appropriately commenced on PPI treatment. Less than 25% of patients discharged on a PPI had discharge information recommending duration of treatment or review. In the "appropriate" group 30 patients (86%) were discharged on omeprazole, and 13/21 (62%) evaluable patients remained on this at 6 months. In the "inappropriate" group 15 (65%) were discharged on omeprazole, and 10/14 (71%) evaluable patients remained on this at 6 months. Older patients remained on omeprazole for a longer duration but appropriateness of commencement did not influence the duration of treatment. Dose titration was attempted for 10 (29%) patients including three from the "inappropriate" group. CONCLUSION: Care should be taken to commence PPIs only when clinically indicated. Discharge information to GPs, especially recommendations for duration of treatment and/or dose titration, requires improvement.

Antimicrobial drug utilisation in Dunedin Hospital, New Zealand, and its association with antimicrobial resistance.

INTRODUCTION: Antimicrobial resistance (AR) to a drug can be considered a natural response to the selection pressure of that drug, with over prescribing being one of the major causes. Few investigations have evaluated the relationships between antimicrobial drug use in a hospital and antimicrobial resistance. METHOD AND MATERIALS: Antimicrobial drug utilisation (AU) data were collated for Dunedin Hospital, New Zealand, and expressed as defined daily doses per 1000 patient days according to the World Health Organization's definition. The drug groups studied were glycopeptides, carbapenems, third and fourth generation cephalosporins and fluoroquinolones. Antibiograms were also analysed and possible associations between antimicrobial utilisation and resistance were investigated. The reduction of antimicrobial utilisation has also been explored by various means. RESULTS: The utilisation of fluoroquinolones at Dunedin Hospital was high compared with hospitals in South Australia, increasing from 1999 to 2003 then decreasing in 2004 and 2005. The Spearman rank correlation coefficients for the associations between fluoroquinolone utilisation and resistance to ciprofloxacin were: rs = 0.79, p = 0.06 for Pseudomonas aeruginosa and rs = -0.37, p = 0.5 for Escherichia coli. CONCLUSION: The findings of antimicrobial drug utilisation studies in hospital can serve to describe the pattern of drug use in the institution, to detect areas of concern, and to evaluate the impact of interventions taken to influence the use of drugs, especially when this use is associated with increasing antimicrobial drug resistance.