Cephalosporin utilisation review and evaluation

The clinical misuse of drugs may result in preventable patient morbidity and mortality, costly remedial care, additional costs for diagnosis and management of iatrogenic disease and unnecessary wastage of healthcare resources. In recognition of this problem, drug utilisation evaluation (DUE) has been recommended as a method for identifying inappropriate or unnecessary drug use and for promoting rational therapy. Growing concern over the widespread misuse of antibiotics, together with the emergence of antimicrobial resistance and escalating expenditures, has resulted in antibiotics being the drugs most frequently chosen for DUE projects. Cephalosporin DUE is well documented as being successful for modifying cephalosporin use and for containing drug expenditure. Studies range from isolated projects to ongoing programmes that comprehensively evaluate cephalosporin use and the impact of corrective strategies. Sensible use of antibiotics requires a clear understanding of the infectious process, the clinical pharmacology of anti-infective agents and an appreciation of clinical and microbiological monitoring and assessment. Audit criteria that incorporate the above principles, and which are described in the studies reviewed in this article, will be useful for other investigators. Through its DUE programme, the Royal Adelaide Hospital has investigated the use of cephalosporins, including ceftriaxone, ceftazidime and cefoxitin. These reviews have resulted in improvements in cephalosporin use and significant cost savings. Alterations to cephalosporin use that were recommended following these reviews have not resulted in adverse changes to post-operative infection rates, clinical outcomes or adverse drug reactions. This experience, combined with that of other investigators, serves as a useful model for the promotion of rational and economical therapy with cephalosporins and other drug groups.