[Good clinical practice in using antibiotics in the hospital. Current status in 207 public and private hospitals in 1999].
OBJECTIVE
The purpose of this study was to map activities developed in hospitals to monitor antibiotic usage and evaluate implementation of French guidelines for good clinical practice on use of antibiotics in the hospital setting.


METHODS
A questionnaire was mailed to the head of the pharmacy of 300 French hospitals. The questionnaire targeted methods developed to monitor antibiotic usage (antibiotic committees, local recommendations, types of prescription and dispensing, surveillance, information and evaluation activities).


RESULTS
The response rate was 69% (207 answers). A local committee supervised antibiotic usage in 49% of the hospitals (nosocomial, drug or antibiotic committees). Local recommendations existed in 120 hospitals (59%) and 42% of the hospitals had a validation process before dispensing drug in accordance with the recommendations. Antibiotic prescription was nominal in 65% of the hospitals and specific monitoring was carried out in 42% of them. Antibiotic consumption was monitored in 80% of the hospitals and resistance was monitored in 53%. Twelve percent of the hospitals used an electronic network to share information on prescription and bacteriological results. Regular internal training existed in 20% of the hospitals and evaluation methods (medical audits, impact measures) in 14%.


CONCLUSIONS
Careful monitoring of antibiotics is implemented in most hospitals. Strict application of guidelines, definition and implementation of indicators, and evaluation methods must be improved. Implementation of better hospital monitoring of antibiotics requires: i) a local consensus to limit the antibiotics available and guidelines to adapt to local infections; ii) dissemination of guidelines and training for prescribers; iii) implementation of a dispensing system to check the validity of prescriptions according to local guidelines; iv) implementation of indicators to monitor bacterial resistance and the volume of antibiotics used.
Gindre
I
I
Service Pharmacie, CHU Brabois Adultes, Vandoeuvre-lès-Nancy. zzgindre@club-internet.fr
Maisonneuve
H
H
Riche
B
B
Durocher
A
A
D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005602:France; D016304:Hospitals, Private / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D017410:Practice Guidelines as Topic
D000900:Anti-Bacterial Agents