title: Critical steps in fluoroquinolones and carbapenems prescriptions: results from a prospective clinical audit.
abstract: Antibiotic misuse is associated with emergence of resistance and high expenditures. Fluoroquinolones (FQ) and carbapenems (CP) are drugs with considerable potential of resistance development and its disseminated use is a concern. We undertook a prospective clinical audit to evaluate prescriptions of FQ and CP in a multistep process. Each prescription was unfolded in the following steps: indication for antimicrobial therapy; adequacy of initial prescription, dosage and route; previous cultures; and parenteral-oral transition. There was no antibiotics indication in 8.9% of FQ and 1.5% of CP group (p = 0.07). In CP 25.8% of initial schemes were inappropriate (21% in FQ). Lack of switch to oral therapy comprised 25% of monthly costs of FQ. Inadequacy in initial choice accounted for 13.6% of CP expenses. We concluded that, in spite of infection control restrictive policies, inappropriateness of antibiotic usage is worrisome. Clinical audit in a multistep approach may identify possible flaws in this process.
authors.affiliation: Hospital Infection Control Committee, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. seligman@via-rs.net
authors.forename: B G S
authors.initials: BG
authors.lastname: Seligman
authors.forename: R A
authors.initials: RA
authors.lastname: Ribeiro
authors.forename: R de S
authors.initials: Rde S
authors.lastname: Kuchenbecker
authors.forename: A O
authors.initials: AO
authors.lastname: Grings
authors.forename: R P
authors.initials: RP
authors.lastname: Dos Santos
authors.forename: A R L
authors.initials: AR
authors.lastname: Machado
authors.forename: F C
authors.initials: FC
authors.lastname: Casali
authors.forename: F
authors.initials: F
authors.lastname: Guzatto
authors.forename: V D
authors.initials: VD
authors.lastname: Morais
authors.forename: G
authors.initials: G
authors.lastname: Schroeder
authors.forename: N M
authors.initials: NM
authors.lastname: Küplich
authors.forename: M R
authors.initials: MR
authors.lastname: Pires
authors.forename: L R
authors.initials: LR
authors.lastname: Konkewicz
authors.forename: T
authors.initials: T
authors.lastname: Jacoby
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D015780:Carbapenems / Q000191:economics / Q000627:therapeutic use*; D011307:Drug Prescriptions; D024881:Drug Resistance, Bacterial; D024841:Fluoroquinolones / Q000191:economics / Q000627:therapeutic use*; D006300:Health Services Misuse; D006801:Humans; D008485:Medical Audit; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D024841:Fluoroquinolones