Related Experiment Videos
An audit of first generation cephalosporin usage
N Shetty1, R I Shulman, G M Scott
1Department of Clinical Microbiology, University College London Hospitals, London.
Abstract:
Cefadroxil is a semi-synthetic first generation oral cephalosporin with advantages of almost 100% excretion in the urine within six hours and low cost. It was freely available in the formulary and we undertook an audit of its usage, the indications cited, underlying clinical conditions and relevant microbiology in 106 cases. Following the audit, cefadroxil was restricted, available only on the advice of a microbiologist. Subsequently, another survey was carried out to document the reasons for requesting cefadroxil by clinical staff and the alternatives suggested in each case. The first survey revealed that in 91% cases, cefadroxil had been used inappropriately. The second suggested that the reasons for requesting it were based upon misunderstanding by clinicians as to its value. The only useful indication identified was the treatment of susceptible bacteruria in pregnancy. A suitable oral alternative could be identified for all other cases where an antibiotic was indicated. We believe that first generation cephalosporins such as cefadroxil have little role in hospital practice and should therefore be restricted.
Insights
Cefadroxil, an oral cephalosporin, was frequently misused in hospitals. Audits revealed inappropriate usage in 91% of cases, highlighting a need to restrict its availability and improve clinical understanding of its limited therapeutic value.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Cefadroxil, a first-generation oral cephalosporin, is known for rapid urinary excretion and affordability.
- Historically, it was freely available in hospital formularies.
- Audits were conducted to assess its actual clinical utility and prescribing patterns.
Purpose of the Study:
- To audit the usage, indications, and microbiology of cefadroxil in 106 cases.
- To evaluate the impact of restricting cefadroxil availability on clinical practice.
- To understand clinicians' reasons for requesting cefadroxil and identify appropriate alternatives.
Main Methods:
- An initial audit of 106 cefadroxil prescriptions.
- Restriction of cefadroxil availability, requiring microbiologist consultation.
- A subsequent survey to assess reasons for requests and suggested alternatives.
Main Results:
- The initial audit found 91% of cefadroxil use to be inappropriate.
- Post-restriction survey indicated clinician misunderstanding of cefadroxil's value.
- Susceptible bacteriuria in pregnancy was the only identified appropriate indication.
Conclusions:
- Cefadroxil is often inappropriately prescribed due to a misunderstanding of its clinical utility.
- Effective oral antibiotic alternatives exist for most indications where cefadroxil was previously used.
- First-generation cephalosporins, including cefadroxil, have limited roles in hospital settings and warrant restricted use.