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Updated: May 10, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Risk of medication safety incidents with antibiotic use measured by defined daily doses
Anas Hamad1, Gillian Cavell, Paul Wade
1King's College London, King's Health Partners, Pharmaceutical Science Clinical Academic Group, Institute of Pharmaceutical Science, Franklin-Wilkins Building, 150 Stamford St, London, SE1 9NH, UK, anas.hamad@kcl.ac.uk.
Background:
Medication incidents (MIs) account for 11.3 % of all reported patient-safety incidents in England and Wales. Approximately one-third of inpatients are prescribed an antibiotic at some point during their hospital stay. The WHO has identified incident reporting as one solution to reduce the recurrence of adverse incidents.
Objectives:
The aim of this study was to determine the number and nature of reported antibiotic-associated MIs occurring in inpatients and to use defined daily doses (DDDs) to calculate the incident rate for the antibiotics most commonly associated with MIs at each hospital.
Setting:
Two UK acute NHS teaching hospitals.
Methods:
Retrospective quantitative analysis was performed on antibiotic-associated MIs reported to the risk management system over a 2-year period. Quality-assurance measures were undertaken before analysis. The study was approved by the clinical audit departments at both hospitals. Drug consumption data from each hospital were used to calculate the DDD for each antibiotic.
Main Outcome Measures:
The number of antibiotic-related MIs reported and the incident rate for the 10 antibiotics most commonly associated with MIs at each hospital.
Results:
Healthcare staff submitted 6,756 reports, of which 885 (13.1 %) included antibiotics. This resulted in a total of 959 MIs. Most MIs occurred during prescribing (42.4 %, n = 407) and administration (40.0 %, n = 384) stages. Most common types of MIs were omission/delay (26.3 %, n = 252), and dose/frequency (17.9 %, n = 172). Penicillins (34.5 %, n = 331) and aminoglycosides (16.6 %, n = 159) were the most frequently reported groups with co-amoxiclav (16.8 %, n = 161) and gentamicin (14.1 %, n = 135) the most frequently reported drugs. Using DDDs to assess the incident rate showed that cefotaxime (105.4/10,000 DDDs), gentamicin (25.7/10,000 DDDs) and vancomycin (23.7/10,000 DDDs) had the highest rates.
Conclusions:
This study highlights that detailed analysis of data from reports is essential in understanding MIs and developing strategies to prevent their recurrence. Using DDDs in the analysis of MIs allowed determination of an incident rate providing more useful information than the absolute numbers alone. It also highlighted the disproportionate risk associated with less commonly prescribed antibiotics not identified using MI reporting rates alone.
Insights
Medication incidents involving antibiotics are common in hospitals, particularly during prescribing and administration. Analyzing these using defined daily doses (DDDs) reveals higher risks for certain antibiotics, aiding prevention strategies.
Area of Science:
- Patient Safety
- Pharmacovigilance
- Healthcare Quality Improvement
Background:
- Medication incidents (MIs) constitute 11.3% of patient-safety incidents in England and Wales.
- Antibiotics are prescribed to approximately one-third of inpatients.
- The WHO recommends incident reporting to reduce adverse events.
Purpose of the Study:
- To determine the number and nature of reported antibiotic-associated MIs in inpatients.
- To calculate incident rates for the most common antibiotics using defined daily doses (DDDs).
Main Methods:
- Retrospective analysis of antibiotic-associated MIs reported over two years in two UK hospitals.
- Quality-assurance measures and clinical audit approval were obtained.
- Drug consumption data were used to calculate DDDs for incident rate calculation.
Main Results:
- 885 of 6,756 reports (13.1%) involved antibiotics, totaling 959 MIs.
- Most MIs occurred during prescribing (42.4%) and administration (40.0%), with omission/delay (26.3%) and dose/frequency (17.9%) being common types.
- Cefotaxime, gentamicin, and vancomycin showed the highest incident rates per 10,000 DDDs.
Conclusions:
- Detailed analysis of MI reports is crucial for understanding and preventing recurrence.
- Using DDDs provides more valuable insights into MI rates than absolute numbers alone.
- This method identified disproportionate risks with less commonly prescribed antibiotics.
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