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Quality of use of parenteral metronidazole therapy in a teaching hospital
Abstract:
The recent release, relatively high cost and potential adverse effects of parenterally administered metronidazole prompted a quality-of-use audit at a 1000-bed teaching hospital. Ninety-two courses of treatment in 81 inpatients during a 6-week period were studied. Appropriateness of therapy was assessed on the basis of published indications. Parenterally administered metronidazole was prescribed primarily in anaerobic and anaerobic-aerobic infections. It was used as frequently for prophylaxis as for therapy. Surgical services accounted for 95% of the treatment courses. Inappropriate use was noted in 27 (29%) of the courses: agents other than parenterally administered metronidazole were indicated in 12 (13%), while the dose, dosing interval or duration of treatment was suboptimal in 15 (16%). Substantial savings would be achieved if oral or rectal metronidazole therapy were substituted for intravenous therapy for perioperative prophylaxis in elective colorectal surgery. Written justification for use and automatic stop orders are recommended to improve the cost effectiveness of both prophylactic and therapeutic use of selected antimicrobial agents.
Insights
Parenteral metronidazole use in hospitals was audited, revealing inappropriate prescribing in 29% of cases. Switching to oral or rectal forms for prophylaxis could significantly reduce costs and improve antimicrobial stewardship.
Area of Science:
- Infectious Diseases
- Pharmacology
- Hospital Pharmacy
Background:
- Parenteral metronidazole, a commonly used antibiotic, has a high cost and potential adverse effects.
- A quality-of-use audit was initiated due to concerns regarding metronidazole's recent release and associated risks.
Purpose of the Study:
- To assess the appropriateness of parenteral metronidazole prescribing in a large teaching hospital.
- To identify areas for improvement in the cost-effectiveness and utilization of metronidazole therapy.
Main Methods:
- A 6-week audit of 92 treatment courses in 81 inpatients at a 1000-bed teaching hospital.
- Therapy appropriateness was evaluated against established clinical indications for metronidazole use.
- Prescribing patterns, including indications, prophylaxis vs. therapy, and surgical service utilization, were analyzed.
Main Results:
- Parenteral metronidazole was primarily used for anaerobic and mixed aerobic-anaerobic infections, and equally for prophylaxis and therapy.
- Surgical services accounted for 95% of all prescribed treatment courses.
- Inappropriate use was observed in 29% of cases: 13% indicated alternative agents, and 16% had suboptimal dosing or duration.
Conclusions:
- Significant cost savings are achievable by substituting oral or rectal metronidazole for intravenous administration in perioperative prophylaxis for colorectal surgery.
- Implementing written justification for use and automatic stop orders can enhance the cost-effectiveness of antimicrobial agents.
- Improved antimicrobial stewardship is recommended for both prophylactic and therapeutic metronidazole applications.