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Updated: Jul 10, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Impact of antibiotic restriction on broad spectrum antibiotic usage in the ICU of a developing country

Shahla Siddiqui1, Kashif Hussein, Roshan Manasia

  • 1Department of Anaesthesia, Aga Khan University, Karachi.

JPMA. the Journal of the Pakistan Medical Association
|November 10, 2007
PubMed
Abstract

Insights

Implementing an antibiotic restriction policy significantly reduced broad-spectrum antibiotic use by 34% and lowered pharmacy costs by 40%. This initiative also led to a decline in ventilator-associated pneumonia rates.

Area of Science:

  • Infectious Diseases
  • Hospital Pharmacy
  • Critical Care Medicine

Background:

  • Nosocomial pneumonia and high antibiotic costs are significant challenges in intensive care units (ICUs).
  • Broad-spectrum antibiotic overuse contributes to antimicrobial resistance and increased healthcare expenditure.

Purpose of the Study:

  • To decrease the incidence of nosocomial pneumonia.
  • To reduce the financial burden associated with antibiotic therapy in the ICU.

Main Methods:

  • A policy restricted the use of broad-spectrum antibiotics (Cefepime, Meropenem, Imipenem, Tazocin, Polymixin B, Vancomycin) to 72 hours in the ICU, requiring pharmacy and therapeutic committee approval.
  • ICU pharmacists monitored antibiotic orders, alerting clinicians before automatic expiration and facilitating consultations with infectious disease specialists.
  • Antibiotic consumption was standardized using defined daily doses (DDDs) per 1000 patient-days.

Main Results:

  • A 34% cumulative reduction in the use of all broad-spectrum antibiotics was observed.
  • Significant reductions were noted in Tazocin (190 DDDs) and Meropenem (60 DDDs) usage.
  • Overall broad-spectrum antibiotic pharmacy costs decreased by 40%, while ventilator-associated pneumonia rates declined.

Conclusions:

  • Streamlining the antibiotic formulary and implementing a restriction program, guided by infectious disease expertise, effectively reduced broad-spectrum antibiotic utilization.
  • The policy demonstrated success in controlling antibiotic choices, leading to substantial decreases in both usage and expenditure.
  • While multidrug-resistant organism rates remained stable, the reduction in ventilator-associated pneumonia indicates a positive impact on patient outcomes.

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