[Antibiotic use and misuse at the National University Hospital, Iceland.]

Antibiotics are responsible for 20-25% of the total drug-cost in the larger hospitals in Iceland. Studies from other countries, both in Europe and North-America suggest that 40-70% of both antibiotic therapy and prophylaxis is inappropriate in the larger teaching hospitals. We undertook a prospective study to determine the patterns of antimicrobial use in a university hospital.

Data on antibiotic prescriptions were collected over two four week periods in April and August 1994 on 12 wards at the National University Hospital.

During the eight weeks 302 (30%) of 1020 hospitalized medical, surgical and gynecological patients received one or more courses of antimicrobial therapy. Presumptive infection was the reason for therapy in 73% of the cases, prophylaxis in 35% and both therapy and prophylaxis in 8%. Cephalosporins were the most commonly used drugs for antimicrobial therapy and cloxacillin for prophylaxis. Therapy was judged appropriate in only 45% of the courses. Poor drug choice (bacterologically, pharmacologically), misguided prophylaxis, wrong drug dosage or unneccessary therapy were the most frequent reason for inappropriate therapy.

Because of the worldwide increase of antibiotic-resistant strains the results of this study clearly indicate the need for additional measures to improve antibiotic use.