Compliance with an infectious disease specialist's advisory consultations on targeted antibiotic usage

This study was conducted to evaluate the appropriateness of the use of targeted antibiotics, and to analyze compliance and the short-term impact of targeted antibiotic advisory consultations, as implemented in our hospital in October 2002. Targeted antibiotics included glycopeptides, carbapenems, antipseudomonal cephalosporins, and aminoglycosides. A total of 339 prescriptions were reviewed from October 2002 through March 2003. Antimicrobial utilization density (AUD), which was the defined daily dose divided by 1000 patient days, was compared quarterly. Overall, 85.6% of the prescriptions were inappropriate, with 73.7% being inappropriate for therapeutic use and 100% inappropriate for prophylactic use. The overall compliance rate of attending physicians with the antibiotic advisory consultations was 46.5%. Compliance was higher in medical services than in surgical services (64.2% vs 43.1%; P = 0.005) and for therapeutic use than for prophylactic use (54.7% vs 36.5%; P = 0.001). The use of all parenteral antibiotics in the hospital decreased, from 770.8 AUD during the first quarter in 2002 to 626.8 AUD during the second quarter in 2003 (P < 0.01). In conclusion, inappropriate antibiotic use for treatment and prophylaxis is common in our hospital. A targeted antibiotic advisory consultation may be an alternative means of ensuring more appropriate antibiotic use. However, more efficient antibiotic control measures should be developed and implemented, and prospective and continuous monitoring of antibiotic use is required.