Drug use evaluation of antibiotics in a pediatric teaching hospital
K R Lee1, R J Leggiadro, K J Burch
1Le Bonheur Children's Medical Center, Memphis, TN 38103.
Objective:
To determine the incidence and type of antibiotic use variances at our institution.
Design:
Inpatient bacterial culture and susceptibility results were reviewed for 1 week per month. Medication administration records were evaluated to determine whether antibiotic selection was appropriate, given the susceptibility of the organism. Process indicators included use of the least costly antibiotic, as well as appropriate dose, interval, and route of administration. The complete medical record was reviewed for all patients if management did not appear to meet criteria.
Setting:
A 225-bed, tertiary-care children's teaching hospital.
Results:
Thirty-five (8.2%) of 428 patients reviewed over 12 months had a total of 49 variances: failure to treat (3), treatment of contaminant/colonizer (2), use of more costly agent (10), failure to revise therapy (8), inappropriate route (2), inappropriate empiric antibiotic (4), incorrect dose (3), unnecessary multiple antibiotics (6), inappropriate drug (8), and prolonged prophylaxis (3).
Conclusions:
Thirty-five patients with 10 types of variances were identified during the study. Follow-up monitoring will assess the impact of educational efforts on the incidence of variances. Specific problem antibiotics have been identified for further audits.
Insights
Antibiotic use variances were identified in 8.2% of pediatric patients, including inappropriate selection and dosing. Educational interventions are planned to reduce these common antibiotic stewardship issues.
Area of Science:
- Pharmacology
- Infectious Diseases
- Pediatric Medicine
Background:
- Antibiotic stewardship is crucial for combating antimicrobial resistance.
- Variances in antibiotic prescribing can lead to suboptimal patient outcomes and increased healthcare costs.
Purpose of the Study:
- To determine the incidence and types of antibiotic use variances in a pediatric tertiary-care hospital.
- To identify specific areas for improvement in antibiotic prescribing practices.
Main Methods:
- A retrospective review of inpatient bacterial culture and susceptibility results over 12 months.
- Evaluation of medication administration records for appropriateness of antibiotic selection, dose, interval, and route.
- Inclusion of cost-effectiveness and therapy revision as process indicators.
Main Results:
- Thirty-five (8.2%) of 428 patients experienced 49 variances.
- Common variances included use of more costly agents (10), failure to revise therapy (8), and inappropriate drug selection (8).
- Other variances involved treatment failures, inappropriate empiric use, incorrect dosing, and prolonged prophylaxis.
Conclusions:
- Ten distinct types of antibiotic use variances were identified in pediatric patients.
- Further audits will focus on specific problematic antibiotics.
- Educational initiatives will be implemented to address identified variances and improve antibiotic stewardship.
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