title: Aminoglycoside use monitored by clinical pharmaceutical services.
abstract: A pharmacy-infectious diseases program designed to promote the rational use of, and decrease the adverse reactions attributed to, amikacin and tobramycin is described. Requests for amikacin and tobramycin were screened initially by a pharmacist and later reviewed by an infectious disease physician. When the appropriateness of amikacin or tobramycin use was questionable, the drug was released pending review of the order by the chief of infectious diseases. Pharmacists, in consultation with the infectious diseases service, made recommendations for alternative antibiotic therapy or dosage regimens, provided drug education to prescribing physicians and nurses, and aided in monitoring efficacy and toxicity of therapy. During a two-year period, 12 patients received tobramycin and 42 patients received amikacin. The drugs were discontinued as recommended in the 12 patients for whom culture results were negative or indicated sensitivity to other antibiotics. Two initial requests for the drugs were denied. No incidents of renal impairment were definitely associated with tobramycin or amikacin use. During an 18-month portion of the study, the two drugs accounted for approximately 2% of the hospital's total aminoglycoside costs and 4% of the total number of aminoglycoside therapy courses. Monitoring of antibiotic use may promote safe, rational antibiotic use and potentially reduces hospital costs.
mesh_terms: D000583:Amikacin; D000900:Anti-Bacterial Agents; D002140:California; D004363:Drug Utilization; D006748:Hospital Departments; D006785:Hospitals, University; D006801:Humans; D007239:Infections; D007612:Kanamycin / Q000031:analogs & derivatives; D010607:Pharmacy Service, Hospital; D014031:Tobramycin; D014600:Utilization Review / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents; D007612:Kanamycin; D000583:Amikacin; D014031:Tobramycin