[Use of drugs in the hospital. Retrospective model study]

This study sets out to describe and evaluate antimicrobial therapy in the departments of surgery, medicine, gynecology and obstetrics of a 500-bed general hospital serving a mainly metropolitan population. About one third (605) of 2002 hospitalized patients received chemotherapy, 97 patients being treated for nosocomial infections. In 44% antimicrobials were given prophylactically, chiefly in the surgical department (in 60% of the drug courses) and the departments of gynecology (in 78%) and obstetrics (in 71%). Combinations (excluding sulphamethoxazole/ trimethoprim) were used on the medical wards in 5% and on the surgical wards in 15% of the drug courses. Gentamycin combined with beta-lactam antibiotics was most often used in medicine, while penicillin/streptomycin and ampicillin/cloxacillin in fixed ratios were the most frequent combinations in surgery. Finally, each therapy was evaluated by two experts as either rational, irrational or questionable. 61% of the 681 drug courses were considered rational, 16% questionable and 23% irrational. In the 155 irrational drug courses, one or more of the following criticisms were made: inappropriate chemoprophylaxis (101), wrong drug in chemoprophylaxis (66), inappropriate combination (30), wrong drug in symptomatic chemotherapy (28), no bacteriological diagnosis (26), sensitivity test not considered (17), use of antagonistic combinations (11) and wrong drug in therapeutic chemotherapy (5).