[Prospective assessment of glycopeptides prescriptions in a general hospital]

The authors had for aim to analyze the indications, quality, and volumes of glycopeptide (GP) prescriptions in all in-patient units of a general hospital. CLINICAL MATERIAL AND METHODOLOGY: A 4 month prospective study assessed the compliance of curative and prophylactic treatment prescriptions administered according to guidelines. The assessment criteria were as follows: prescription indicated or not, prescription modalities (administration of loading dose, performing of serum tests, dosage appropriateness, appropriateness with antibiogram data when available).

Over the 46 assessed prescriptions, 84.7% were curative treatments (N = 39), whereas 15.2% (N = 7) were written out for surgical antibioprophylaxis. The prescription incidence and density were, respectively, 0.60 prescription/100 admissions and 20.8 DDJ/1000 hospitalization days, i.e. 24% of the total antibiotics budget. Prescriptions were always indicated for surgical antibioprophylaxis, but met standards in only 14% of cases. As for curative prescriptions, treatments were appropriate in 56.5% of cases, but only 18% met standards. GP use modalities proved incorrect at various levels: non existing load dose and lack of serum tests, subinhibiting daily doses, no dose lowering when possible, exaggerated duration of surgical antibioprophylaxis. Average GP serum levels were 16 mg/L and were higher than the target level in no more than 40% of properly prescribed treatments.

Prescription modalities and treatment monitoring must be improved, given the development of bacterial resistance.