Critical steps in fluoroquinolones and carbapenems prescriptions: results from a prospective clinical audit.
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.
Seligman
B G S
BG
Hospital Infection Control Committee, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. seligman@via-rs.net
Ribeiro
R A
RA
Kuchenbecker
R de S
Rde S
Grings
A O
AO
Dos Santos
R P
RP
Machado
A R L
AR
Casali
F C
FC
Guzatto
F
F
Morais
V D
VD
Schroeder
G
G
Küplich
N M
NM
Pires
M R
MR
Konkewicz
L R
LR
Jacoby
T
T
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
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D024841:Fluoroquinolones