Evaluation of antibiotic use in a hospital with an antibiotic restriction policy

The study was designed to evaluate rational antibiotic use in relation to diagnosis and bacteriological findings. All hospitalized patients who received antibiotics were evaluated by a cross-sectional study. Of the 713 patients hospitalized, 281 (39.4%) patients received 377 antibiotics. Among 30 different antibiotics the most frequently requested were first generation cephalosporins (19.9%), ampicillin-sulbactam (19.1%) and aminoglycosides (11.7%). Antibiotic use was appropriate in 64.2% of antibiotic requests. In analysis of appropriate use, a request after an infectious diseases consultation was a frequent reason (OR=14, P<0.001, CI=0.02-0.24). Antibiotics requested in conjunction with susceptibility results were found to be more appropriate than those ordered empirically (OR=4.5, P=0.017, CI=0.06-0.76). Inappropriate antibiotic use was significantly higher among unrestricted antibiotics than restricted ones (P<0.001). Irrational antibiotic use was high for unrestricted antibiotics. Additional interventions such as postgraduate training programmes and elaboration of local guidelines could be beneficial.     

Experience with a specific request form for antidepressant drug monitoring

With the introduction of an antidepressant drug monitoring service in this hospital, it became necessary to have a completed request form prior to analysis. The importance of ordering these tests selectively and of basic pharmacokinetics for antidepressants was stressed through special lectures and a newsletter. This study was undertaken to assess whether the use of this form assisted in optimizing drug monitoring of antidepressants. Information provided on the form was used to assist in interpretative reporting and to improve clinical use of the results. Requested information included the name, age, sex, height, and weight of the patient; time of last dose; date therapy started at present dose; reason for the request; and a list of concurrent medications. Results obtained for 600 specimens in 18 months showed that the form was completed fully, sampling time was appropriate, and drug concentration was at steady state 82, 73, and 95% of the time, respectively. Major reasons for requesting analysis were suspicion of subtherapeutic (52%), uncertain (20%), above therapeutic (15%), and toxic (10%) ranges. The most popular monitoring requests were for imipramine (40%), doxepin (28%), amitriptyline (14%), and desipramine (11%). Clinical impression of efficacy in the treatment of endogenous depression agreed with plasma levels 60% of the time in the subtherapeutic range, but agreement was only 32% above the therapeutic range. It was concluded that a special request form helps to assure appropriate sampling, explain observed drug interactions, and facilitate interpretative reporting for the medical and nursing staff.     

Impact of an antibiotic restriction policy on the antibiotic resistance patterns of Gram-negative microorganisms in an Intensive Care Unit in Greece

The purpose of this study was to investigate the influence of an antibiotic policy programme based on restriction of the empirical use of fluoroquinolones and ceftazidime on the susceptibilities of Gram-negative microorganisms in a general Intensive Care Unit (ICU). The epidemiology of infections caused by the predominant ICU pathogens, i.e. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae, and their resistance patterns as well as antibiotic consumption were recorded for a 6-month period. An antibiotic restriction policy including ceftazidime and quinolones was applied. After an 18-month period of protocol application, the same parameters were recorded for another 6-month period. Consumption of restricted and overall antibiotics was reduced by 92.5% and 55.4%, respectively. Susceptibilities to ciprofloxacin of the three predominant infection-causing Gram-negative bacilli were significantly increased. Ceftazidime showed an increase in susceptibility only for P. aeruginosa. Similar rates of infectious episodes were recorded in the two periods and no differences were observed either in overall mortality or in ICU ecology as expressed by the type of microorganisms implicated in colonisation and/or infection. The reported data suggest that an antibiotic restriction policy can significantly reduce antimicrobial consumption and antimicrobial resistance rates, although the latter effect can be also influenced by the prevalent resistance mechanisms and the prevalence of imported resistance.     

深入开展"医院管理年"活动,促进合理应用抗生素

目的:探讨抗生素管理的有效途径,促进合理应用抗生素。方法:深入持续开展“医院管理年”活动,医院成立抗生素管理协作组,制定各临床科室预防用药方案并进行严格管理。结果:我院通过“医院管理年”活动,使抗生素使用率由2004年的83．3%下降到2005年的52．7%:Ⅰ、Ⅱ类手术术前不再预防应用抗生素,手术后用药时间也明显缩短,与管理前比较有明显差异。结论:深入持续开展“医院管理年”活动,对抗生素进行严格管理,可明显降低医院感染率及切口感染率。     

Explaining drug policy: Towards an historical sociology of policy change

The goal of seeking to understand the development over time of drug policies is a specific version of the more general intellectual project of finding ways of explaining social change. The latter has been a preoccupation of some of the greatest thinkers within the social sciences of the last 200 years, from Foucault all the way back to the three nineteenth-century pioneers, Marx, Durkheim and Weber. I describe this body of work as ‘historical sociology’. In this paper, I outline how a particular approach to historical sociology can be fruitfully drawn upon to understand the development of drug policy, using by way of illustration the example of the analysis of a recent transformation in British drug policy: the rise of the criminal justice agenda. I conclude by arguing that by looking at developments in drug policy in this way, some new insights are opened up.     

Hospital antibiotic policy in a health district.

A hospital antibiotic policy is described in which only a few antibiotics were used over a two-year period. Six antibiotics--namely, ampicillin, cloxacillin, cephradine, penicillin, erythromycin, and oxytetracycline--accounted for 98% of the antibiotics consumed. Gentamicin was not used topically. Apart from high levels of resistance to ampicillin in Staphylococcus aureus (80%), the Enterobacteriaceae (37%), and Bacteroides (83%), antibiotic resistance was not a problem and no major epidemics of cross-infection occurred. With this policy antibiotic consumption declined and the total true cost of the antibiotics fell from 16 361 pounds in 1976 to 10 448 pounds in 1978.     

Determination of the antibiotic drug pefloxacin in bulk form,tablets and human serum using square wave cathodic adsorptive stripping voltammetry

A simple, rapid, reliable and fully validated square wave cathodic adsorptive stripping voltammetric procedure has been developed for the determination of the antibiotic pefloxacin drug in bulk form, tablets and human serum, based on its electrochemical reduction at a hanging mercury drop electrode. The Britton–Robinson buffer of pH 7.0 was found to be reasonable as a supporting electrolyte for assay of the drug. Pefloxacin drug, at the optimized conditions, showed a single 2-electron well-defined peak at −1.07 V (versus Ag/AgCl/KCl_s) using an accumulation potential of −0.40 V. This peak may be attributed to the reduction of the C=O group. A mean recovery of 99.54%±0.23 and a detection limit of 1.65×10⁻¹⁰ M pefloxacin were achieved. After being validated, the proposed procedure was successfully applied for the determination of the drug in tablets and human serum with mean recoveries of 99.57±0.48 and 98.55±0.78%, respectively. A detection limit of 4.50×10⁻¹⁰ M was achieved for the determination of the drug in human serum. Results of the proposed procedure were comparable with those obtained by reported methods.     

New method for delivering a hydrophobic drug for photodynamic therapy using pure nanocrystal form of the drug

A carrier-free method for delivery of a hydrophobic drug in its pure form, using nanocrystals (nanosized crystals), is proposed. To demonstrate this technique, nanocrystals of a hydrophobic photosensitizing anticancer drug, 2-devinyl-2-(1-hexyloxyethyl)pyropheophorbide (HPPH), have been synthesized using the reprecipitation method. The resulting drug nanocrystals were monodispersed and stable in aqueous dispersion, without the necessity of an additional stabilizer (surfactant). As shown by confocal microscopy, these pure drug nanocrystals were taken up by the cancer cells with high avidity. Though the fluorescence and photodynamic activity of the drug were substantially quenched in the form of nanocrystals in aqueous suspension, both these characteristics were recovered under in vitro and in vivo conditions. This recovery of drug activity and fluorescence is possibly due to the interaction of nanocrystals with serum albumin, resulting in conversion of the drug nanocrystals into the molecular form. This was confirmed by demonstrating similar recovery in presence of fetal bovine serum (FBS) or bovine serum albumin (BSA). Under similar treatment conditions, the HPPH in nanocrystal form or in 1% Tween-80/water formulation showed comparable in vitro and in vivo efficacy.     

Newspaper coverage of drug policy: an analysis of pre-election reporting of the Greens' drug policy in Australia

INTRODUCTION AND AIMS: With the headline 'Ecstasy Over The Counter' in a popular daily newspaper, the debate on drug policy officially entered the arena of the 2003 New South Wales (Australia) State Election. The debate resurfaced in the lead-up to the 2004 Australian Federal Election. This paper analyses the pre-election coverage of drug policy issues in four Australian newspapers. DESIGN AND METHODS: Four high-circulation daily newspapers were monitored for a one-month period prior to both elections and analysed for their coverage of drug policy, particularly with respect to the policy of the Greens. RESULTS: The newspapers took different perspectives on drug policy issues, with two framing it in emotive terms as a moral debate and two framing it as political manoeuvring. DISCUSSION AND CONCLUSION: The newspapers focused upon emotive and sensationalist factors. They did not provide their readers with information or a rationale for the formulation of drug policy, be this from a harm minimisation or zero tolerance perspective.     

Antibiotic utilization at the university hospital after introducing an antibiotic policy

Objective: Antibiotic formulary restrictions are among the most popular methods to control antibiotic utilization in hospitals. The aim of the present survey was to investigate the influence of “reserve antibiotic” on antimicrobial utilization at the University Hospital Center (UHC) Rijeka. Methods: At the UHC Rijeka, reserve antibiotic was implemented in July 1997. The antimicrobial drug consumption was monitored 6 months prior to and 6 months after the introduction of the method. Antimicrobial consumption was measured in defined daily doses (DDDs) among the major clinics. Results: Reserve antibiotic has led to a decrease in total antibiotic consumption at the UHC Rijeka (45.9 DDDs/100 bed days vs 32.9 DDDs/100 bed days). Antibiotic utilization decreased in the second semester at most clinics: at the Clinic for Infectious Diseases 41%, at the Anesthesiology and Intensive Care Unit 30%, at the Clinic for Internal Medicine 18% and at the Surgical Clinic 12%. At the Clinic for Gynecology and Obstetrics, the antibiotic utilization remained the same, while at the Pediatric Clinic an increase of 28% in antibiotic utilization was noted. Conclusion: Our study indicates that restriction of usage of some antibacterial agents is a successful method to decrease antibiotic consumption and a way to bring cost savings and helps prevent emergence of resistant microorganisms in hospitals. To improve antimicrobial prescribing, additional methods such as education are required. Received: 28 October 1999 / Accepted in revised form: 26 January 2000     

Evaluation of drug physical form during granulation, tabletting and storage

An active pharmaceutical ingredient (API) was found to dissociate from the highly crystalline hydrochloride form to the amorphous free base form, with consequent alterations to tablet properties. Here, a wet granulation manufacturing process has been investigated using in situ Fourier transform (FT)-Raman spectroscopic analyses of granules and tablets prepared with different granulating fluids and under different manufacturing conditions. Dosage form stability under a range of storage stresses was also investigated. Despite the spectral similarities between the two drug forms, low levels of API dissociation could be quantified in the tablets; the technique allowed discrimination of around 4% of the API content as the amorphous free base (i.e. less than 1% of the tablet compression weight). API dissociation was shown to be promoted by extended exposure to moisture. Aqueous granulating fluids and manufacturing delays between granulation and drying stages and storage of the tablets in open conditions at 40 degrees C/75% relative humidity (RH) led to dissociation. In contrast, non-aqueous granulating fluids, with no delay in processing and storage of the tablets in either sealed containers or at lower temperature/humidity prevented detectable dissociation. It is concluded that appropriate manufacturing process and storage conditions for the finished product involved minimising exposure to moisture of the API. Analysis of the drug using FT-Raman spectroscopy allowed rapid optimisation of the process whilst offering quantitative molecular information concerning the dissociation of the drug salt to the amorphous free base form.     

Audit of an antibiotic policy and microbiological investigations for treating bacteraemia in a large teaching hospital

An audit of different approaches to guide empirical therapy in 78 cases of bacteraemia revealed poor utilisation of the antibiotic policy with resulting inadequate (P=0.005) or excessive (P<0.00001) antibiotic treatment and a trend to increased mortality. Eighty-seven percent of blood cultures were positive on Gram-stain within 24 h but streamlined therapy was still judged excessive in 27%. The results show poor utilisation of an up-to-date antibiotic policy but confirm its potential benefits and the ability of traditional culture methods to guide antibiotic therapy in a useful time-scale.