Appropriateness of metronidazole use in a teaching hospital

The appropriateness of metronidazole use at a teaching hospital was determined by a retrospective audit. All orders for metronidazole received by the hospital pharmacy from December 26, 1986, to May 15, 1987, were identified, and the charts of the patients involved were reviewed to determine whether the drug's use was appropriate or inappropriate according to pre-established guidelines for indication, dose, dosage interval, and duration of therapy or prophylaxis. The oral route of administration was considered appropriate for patients who were taking other oral medications or who were on a diet of at least clear fluids. The acquisition cost of metronidazole from January to June 1987 was used to determine the potential cost avoidance that would result if (1) all types of inappropriate use were corrected, or (2) only the inappropriate route of administration were corrected. A total of 104 courses of therapy in 98 patients were evaluated, of which 76 were therapeutic and 28 were prophylactic. Of the 104 courses, 62% were found to be inappropriate by at least one of the criteria for appropriate use, excluding route of administration. Of the 893 doses of metronidazole administered by the i.v. route, 424 (47%) could have been given orally. A drug cost analysis revealed that $3954 (48% of the total hospital expenditure for metronidazole) could have been saved by substituting oral metronidazole for i.v. metronidazole when possible. If all criteria for appropriate use of metronidazole had been followed, $5977 could have been saved, which represents 71% of the current hospital expenditure for metronidazole.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical Appropriateness of Serum Folate ordering pattern in a tertiary care hospital in Saudi Arabia

Folate, also known as vitamin B9, is a co-factor necessary for DNA synthesis. Folate deficiency is associated mainly with hematological findings including megaloblastic anemia and pancytopenia. Many countries have mandated grain fortification with micronutrients including folic acid resulting in a reduced prevalence of folate deficiency. Saudi Arabia imports most of the grain products and folate is usually added after milling. There are no local studies to address the folate deficiency prevalence. In this study we aimed to analyse the clinical appropriateness of ordering practice of serum Folate level.MethodWe reviewed all serum folate requests received at our laboratory in Aseer Central Hospital over one-year period (July 2018 June 2019). We collected patients’ demographics from the electronic requests along with biochemical results of serum B12, ferritin and CBC results. We assessed appropriateness of orders against pre-specified criteria and applied statistical tests to explore for any association or significance.ResultsSerum folate requests from 614 patients were received during the study period. Serum B12 (543, 88%), and serum ferritin (511, 83%) were concurrently requested. The most common reason for request, when available, was anemia. Anemia was present in (313, 51%) of the subjects for which microcytic anemia was predominant (199, 63.5%), followed by normocytic anemia (101, 33%) and only 10 subjects had macrocytic anemia (3.2%). The most common hematinics’ deficiency was ferritin (30%) followed by B12 (17.2%). Serum folate deficiency was low, observed in only 2.8%. Low folate levels were not significantly different between the group with anemia and the normal hemoglobin group.ConclusionThis study identifies a commonly inappropriate serum folate ordering practice that includes ordering all hematinics at the same visit without considering the possible anemia etiologies. The excessive requests might be related to doctors attempt to avoid multiple blood extractions and to try to reduce the time for diagnosis. These policies are generating unnecessary costs and time loss. Education, phasing out or restricting some tests and introducing laboratory policies like sample storing could help reduce unnecessary requests.     

Appropriateness of the use of serum lithium assays

The performance of 222 lithium assays was studied in a psychiatric hospital to determine if their use was appropriate and therapeutically beneficial. Charts of all patients whose serum lithium levels were measured in a month were reviewed to determine whether the assays were indicated, whether they were performed correctly, and whether the dosage was adjusted appropriately. Of the assays reviewed, 16 percent were performed for inappropriate indications and 98 percent were drawn at correct times. Of 157 assays that should not have resulted in a dosage change, 8 changes were made; of 63 assays that should have resulted in a dosage change, only 23 changes were made. Inappropriate orders for assays cost the hospital +5016 per year. If routine serum lithium assay monitoring is changed to a three-month frequency, the total cost savings would be +16,632 per year. Clinical pharmacists with specialized knowledge of clinical pharmacokinetics should work with physicians and treatment teams in monitoring serum drug assays to ensure appropriateness of assay request, more complete interpretation of results, and proper follow up.     

The use of cefotaxime in a community hospital

The use of cefotaxime was monitored to evaluate the appropriateness and cost of its use. This was done by chart review and physician questionnaire. Of 57 patients reviewed, 19 were treated empirically for specific established infections; 19 for sepsis without an identified source; 3 for infections with a known pathogen; and 16 for surgical prophylaxis. In the majority of patients treated empirically for specific infection or sepsis, the use of cefotaxime was judged appropriate by infectious disease consultants, while for surgical prophylaxis, it usually was judged inappropriate. The average charge for cefotaxime was +396 per course vs. +318 for antibiotics commonly used before cefotaxime became available. When used alone, cefotaxime was less expensive to the patient than a combination of antibiotics in 22 of 29 cases. We concluded that cefotaxime was used appropriately for empiric therapy without increasing costs greatly.     

The use of norfloxacin in a university hospital

Because of increasing norfloxacin use and the development of resistant organisms, an evaluation was undertaken in a University Hospital to assess the appropriateness of norfloxacin for the treatment of urinary tract infections and to calculate the potential cost savings associated with more cost-effective antibiotic therapy. Medical records of 64 patients receiving norfloxacin for a 31-day period were concurrently reviewed. Of these, 58 patients were treated for urinary tract infections and four patients received urinary tract infection prophylaxis. Fourteen patients were prescribed solely empiric therapy whereas an additional 44 patients received definitive treatment confirmed by culture results. Based on the predetermined criteria, norfloxacin use for the definitive treatment of urinary tract infections was deemed to be appropriate in 34 of the 44 patients. Three additional courses of therapy were also judged to be appropriate due to documented signs and symptoms associated with urinary tract infections, despite cultures with less than 10(5) colony forming units per mL urine. Reasons for inappropriate use in the remaining seven patients included isolation of fewer bacteria than required by the criteria in asymptomatic patients (3 cases), isolation of organisms not sensitive to norfloxacin (1 case) and lack of dosage adjustment for renal insufficiency (3 cases). Nineteen of 32 evaluable inpatients (59%) received norfloxacin when a less expensive, equally effective agent was available. Although savings from more cost-effective therapy of urinary tract infections are minimal, due to the potential emergence of resistant organisms, norfloxacin should be reserved for infections not amenable to treatment with other oral antibiotics.     

Drug use profile in a Nigerian city hospital

The newly introduced WHO Drug Use Indicators enable the delineation of drug use patterns, identification of inappropriate use and evaluation of interventional strategies. This study highlights the drug use pattern in a city hospital and further identifies areas of inappropriate use that need to be addressed. Records of 614 patient encounters (January-December 1993) were obtained by systematic random sampling at the Central Hospital, Benin City. The WHO prescribing indicators were calculated and detailed review in various therapeutic categories was carried out. The average number of drugs per encounter was 3.7. The percentage of encounters with injection and antibiotics were 37.0% and 54.2% respectively. Forty-eight per cent of drugs were prescribed by generic name and 94.4% of all prescribed products were in the National Essential Drug List. Drugs were not prescribed in 2.8% of encounters. Of injections, 74.1% were for treatment of febrile illness, usually presumed to be malaria. Analgesics/antipyretics, mainly paracetamol, were prescribed in 72.3% of encounters. In 57.8% of encounters vitamin preparations were prescribed. Certain differences were observed between children and adults with children receiving more vitamins and antimalarials. These findings suggest some inappropriate use of drugs which may in turn reflect current practice throughout Nigeria. Proper case management of febrile illness is likely to promote more rational use of drugs.     

Aetiology and therapy of community-acquired pneumonia: a hospital study in northern Italy

Objectives: The primary aim of this study was to determine whether the use of a therapeutic protocol in the treatment of community-acquired pneumonia (CAP) proved equally effective as the initial empirical anti-infective therapy usually employed. A secondary aim was to compare the cost of therapy and the incidence of the pathogens responsible for so-called “atypical” pneumonia in the study area. Methods: A comparison was made between 11 hospital departments agreeing to abide by the study protocol and 12 hospital departments, well matched for size and type, implementing their usual therapy. The protocol provided different anti-infective therapy options for the patients regarded as being at risk and not at risk, and, secondarily, for infections likely to be of the “typical bacterial” or so-called “atypical” type. The main outcome measures were need to change the initial anti-infective therapy owing to inefficacy, final clinical and radiological outcome, mean cost of pharmacological therapy per patient and result of the serological investigations of the pathogens responsible for “atypical” pneumonia. Results: A total of 345 patients with CAP were assessed. The initial therapy was changed in 8.6% of patients treated according to the protocol, and in 24.5% of patients treated with the usual anti-infective therapies. The cost of therapy for the protocol was almost half of that in the control group. Clinical and radiological outcome was similar in the two groups, with a very low mortality rate. The overall proportion of cases of “atypical” pneumonia amounted to 13%. Conclusions: The use of the therapeutic protocol gave an efficacy comparable to that achieved with routine therapy, but at a distinctly lower cost of antibiotic therapy. The use of microbiological investigations is very limited in day-to-day clinical practice, and the incidence of so-called “atypical” pneumonia was low in the study area, apart from specific outbreaks. Received: 28 May 1996 / Accepted in revised form: 21 August 1996     

某院中药注射剂临床合理使用干预的评价

目的评价某院中药注射剂临床合理使用干预措施实施的效果。方法抽取某院使用中药注射剂的2009年11月份出院病历60份作为对照组,使用中药注射剂的2010年11月份出院病历60份作为干预组,对中药注射剂的使用情况进行评价。结果干预组中药注射剂的不合理使用表现,如超适应证、超剂量、溶媒选择及配伍不当等方面有明显改善。结论实施的合理用药干预措施具有可行性和有效性,对促进临床安全、有效、经济地使用中药注射剂起到了积极的作用。     

基层医院外科围手术期抗生素预防性应用分析

目的：评价佛山市南海区狮山镇小塘医院外科围手术期抗生素的应用现状。方法：随机抽取2008年1-9月该院外科手术病例425例,依据《抗菌药物临床应用指导原则》,调查围手术期抗生素的预防性应用情况。结果：该院外科围手术期抗生素应用率达100％;术前0．5～2．0h应用抗菌物占63．53％,术后应用抗生素占100％,抗生素平均应用时间为11．3d,最长达26d。应用的抗生素有6类共22种,其中口服药6种,注射剂16种。结论：该院外科围手术期抗生素应用率偏高、预防性用药疗程过长;各类手术预防用药指征不明确,联合用药比例过高;用药目的和针对性不强,亟待实施规范化管理。     

某院活血化瘀类中药注射剂不合理联用情况与分析

目的：分析临床常见活血化瘀类中药注射剂不合理联用情况。方法：汇总某院2015年全年活血化瘀类中药注射剂联用导致的不良反应,具体分析不合理联用的原因。结果与讨论：活血化瘀类中药注射剂应在中医药理论指导下单独使用,谨慎联用,避免不良反应的发生。     

抗菌药物临床应用专项整治活动在某妇产医院的实施效果分析

目的 了解某专科妇产医院抗菌药物专项整治活动中的实施效果.方法 应用信息系统对2011年1~6月、2012年1~6月抗菌药物使用数据进行统计、计算,对实施效果进行分析、评价.结果 开展抗菌药物临床应用专项整治活动后,该院药品品种数、抗菌药物使用频度（DDDs）、抗菌药物使用强度（AUD）、使用率,Ⅰ类切口预防使用率降低,取得初步成效.结论 通过干预措施的实施,该院抗菌药物管理逐步趋于合理化.通过对整治结果的及时反馈,便于今后进一步提高该院抗菌药物临床合理应用水平.