Therapeutic use of restricted antibacterials in Czechoslovakia

The therapeutic use of restricted antibacterials in Czechoslovakia was studied. Data from 10 hospitals were collected over one year for approximately 10,000 therapeutic applications of eight restricted antibacterials to 8411 patients. The drugs monitored were oxacillin, kanamycin, gentamicin, carbenicillin, co-trimoxazole, colistin, cephalosporins, and lincomycin/clindamycin. Eighty-nine percent of the patients received the restricted antibacterials for therapeutic (rather than prophylactic) purposes. Approximately 16% of these patients received two or more of the drugs, and many of them received nonrestricted antibacterials concurrently. Patients on pediatric, newborn, and prematurely born wards received 55% of the restricted antimicrobials, where oxacillin and gentamicin were used most frequently. Therapy with these drugs was initiated without regard to bacteriological examination for causal bacteria and susceptibility in 7% of all cases, causal bacteria were not reported in an additional 10%, bacterial susceptibility was not determined in another 29%, therapy was administered in 7% of cases in which the bacteria were known not to be susceptible, and confirming susceptibility results were known in advance of therapy in only 30% of the cases. The restricted antibacterials were overused and were frequently prescribed for patients who may not have needed antibacterial therapy at all.