[Evaluation of justification for antibiotic use at the Internal Medicine Clinic of the Clinical Hospital in Zagreb].
OBJECTIVE
Resistance to antimicrobials as the result of unnecessary and inadequate use of antibiotics has become a global health problem. It is estimated that up to 50% of antimicrobials are used unnecessarily, and that they are the cause of approximately 25% of adverse drug reactions. Efforts are made to ensure a controlled use of antibiotics, which is the key strategy against development of resistance to antimicrobials. Since antimicrobial drugs are among the most commonly prescribed drugs in hospitals, a rational use of antibiotics would also help reduce health care costs. There are limited data on the use of antibiotics in Croatian hospitals.


METHODS
This observational study was conducted at the University Department of Medicine, Zagreb University Hospital Center, with the aim to investigate the prevalence of antimicrobial use, indications for antibiotic use, and the necessity and adequacy of antibiotic therapy. The investigated parameters were: prescribed antibiotic (dose, route of administration, duration of therapy), indication for use of antibiotics (prophylaxis, treatment), diagnosis, presence of positive culture, indication documented in medical records, evaluation of antibiotic therapy by a specialist, and risk factors. The most important parameter in the evaluation of the necessity of antimicrobial use was the presence of culture days of treatment, and indication for treatment documented in medical records and evaluated by a specialist. The data were collected over 1 day using a standardized questionnaire.


RESULTS
Fifty of 138 (37%) hospitalized patients were receiving 1 or more antibiotics, most of them (80%) for the treatment of infection. The most frequent diagnoses were sepsis (64%), urinary tract infection (25%), abdominal infection (21%), and pulmonary infection (7%). The median therapy duration was 4 days (minimum 1 day, maximum 121 days). The most frequently prescribed antibiotics were fluoroquinolones (23%), penicillins (23%), aminoglycosides (18%) and cephalosporins (11%). Thirty-nine patients received one or more reserve antibiotics. The median number of received antibiotics was 2 (minimum 1, maximum 5 antibiotics). Risk factors were present in 76% of patients. Fifty-nine percent patients were receiving antibiotics on the basis of culture; in most of them therapy was evaluated by a specialist (98%) and the indication was documented in medical records. Reserve antibiotics were prescribed in 34 patients, in 77% of them on the basis of positive culture.


CONCLUSIONS
The high prescription rate of antibiotics (fluoroquinolones), concomitant use of antibiotics of a similar spectrum of activity and lack of sequential therapy emerged to be the parameters needing further evaluation. Other investigated parameters (number of antibiotics, duration of therapy, necessity of antibiotic therapy) were in accordance with similar studies conducted in hospitals. Further investigation with emphasis on local problems and prescription habits with the aim to optimize the use of antibiotics is needed.
Erdeljić
Viktorija
V
Zavod za klinicku farmakologiju, Klinika za unutrasnje bolesti, Klinicki bolnicki centar Zagreb, Zagreb, Hrvatska. verdeljic@net.hr
Francetić
Igor
I
Macolić Sarinić
Viola
V
Bilusić
Marinko
M
Huić
Mirjana
M
Merćep
Iveta
I
Makar-Ausperger
Ksenija
K
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017523:Croatia; D004363:Drug Utilization; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000188:drug therapy; D007388:Internal Medicine
D000900:Anti-Bacterial Agents