title: Inappropriate prescribing of aminoglycosides: risk factors and impact of an antibiotic control team.
abstract: OBJECTIVE
  Many factors are involved in the appropriate use of aminoglycosides, such as modalities of administration, drug levels monitoring and duration of treatment. We assessed prospectively the impact of an antibiotic control team on the appropriateness of prescriptions.
  
  
  METHODS
  After a first observational audit assessing the appropriateness of prescriptions, and issuing updated recommendations, we performed an interventional audit, where an antibiotic control team provided counselling when prescriptions were considered inappropriate. Appropriateness of prescriptions, clinical outcomes of patients and medical costs were compared between the two periods.
  
  
  RESULTS
  One hundred consecutive prescriptions were analysed in each period, and 32% of prescriptions were modified by the control team. As compared with the observational period, prescriptions in the intervention period were more appropriate with regard to treatment duration (73% versus 56%, P = 0.01) and drug levels monitoring (61% versus 40%, P = 0.05), and the median treatment duration was shorter (4 versus 6 days, P = 0.0002). Independent factors associated with appropriate treatment duration were hospitalization in intensive care unit [adjusted odds ratio (aOR), 4.46; 95% confidence interval (CI), 1.60-12.46], polymicrobial infection (aOR, 3.97; 1.32-11.92) and antibiotic control team intervention (aOR, 2.49; 1.27-4.87). The intervention period was associated with lower rate of nephrotoxicity (15% versus 4%, P = 0.01) and lower direct medical costs (4,039.4 Euros per 100 persons treated).
  
  
  CONCLUSIONS
  Aminoglycoside use was frequently associated with excessive treatment duration and incorrect drug level monitoring. Reinforcing practice guidelines through direct counselling improved the appropriateness of prescriptions.
authors.affiliation: Service de Réanimation Médicale, Hôpital Henri Mondor (AP-HP), Créteil, France.
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Christophe
authors.initials: C
authors.lastname: Rioux
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Girou
authors.forename: Anne
authors.initials: A
authors.lastname: Hulin
authors.forename: Colette
authors.initials: C
authors.lastname: Sauve
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bernier-Combes
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.forename: Philippe
authors.initials: P
authors.lastname: Lesprit
mesh_terms: D000368:Aged; D000617:Aminoglycosides / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D003428:Cross Infection / Q000188:drug therapy; D011307:Drug Prescriptions / Q000191:economics; D017723:Drug Utilization Review; D006801:Humans; D008875:Middle Aged; D051437:Renal Insufficiency / Q000139:chemically induced / Q000191:economics / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents