Utilization of Restricted Antibiotics in a University Hospital in Thailand

Abstract

Antibiotic resistance, a major negative consequence of antibiotic overuse, is

one of the mainstay problems 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 antimicrobial in a 1,000-bed university hospital.

Antimicrobial agents which are 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,

Department of Internal Medicine from June - November 2000, and all relevant data

were assessed. The appropriateness of antibiotic use was 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. A better monitoring and strictly control the use of the problematic

antibiotics, i.e. ceftazidime, imipenem/cilastatin or meropenem and vancomycin are

essential to promote the rational drug use as well as to reduce drug resistance.