Intravenous metronidazole: a drug utilization review in a community hospital

The recent release, relatively high cost and extensive usage of intravenous metronidazole, in a 690-bed community hospital, prompted a drug utilization review of this antimicrobial agent. The review was retrospective and occurred over the period of October 25, 1984, to April 10, 1985. All patients started on intravenous metronidazole were assessed. The quality of use of intravenous metronidazole was determined on the basis of pre-established criteria, which were developed from the literature and in consultation with the hospital's Medical Microbiologist. These criteria were approved by a peer review committee of medical staff. Drug utilization was assessed as either appropriate or inappropriate. Appropriate therapy implied compliance with all of the criteria for appropriate intravenous metronidazole use with respect to indication, dose, dosage frequency, timing of perioperative prophylaxis, duration of use, and concurrent antimicrobial drug use, when metronidazole was prescribed for prophylaxis, empiric treatment or treatment of a documented infection (documented treatment). Inappropriate use implied non-compliance with one or more of the criteria. Fifty-four courses of intravenous metronidazole in fifty in-patients were reviewed. Of the total usage of intravenous metronidazole, 50%, was judged to be inappropriate. Although the Surgical Services accounted for 56% of the total usage, only 13% of the total intravenous metronidazole use was for surgical prophylaxis. Of these cases, 57% were inappropriate. Seventy percent of the total intravenous metronidazole use was for empiric treatment; 53% of these cases were considered inappropriate. The reasons cited most frequently for inappropriate prophylactic or empiric use were inappropriate indication and inappropriate dosage frequency.(ABSTRACT TRUNCATED AT 250 WORDS)