Impact of antibiotic restriction on broad spectrum antibiotic usage in the ICU of a developing country.
OBJECTIVE
To reduce rates of nosocomial pneumonia and cost of antibiotic therapy.


METHODS
By means of a policy implementation the following broad spectrum antibiotics were restricted to usage in the ICU for 72 hours: Cefepime, Meropenem, Imipenem, Tazocin, Polymixin B and Vancomycin, after an institutional based pharmacy and therapeutic committee approval. The ICU pharmacist would alert the ICU residents or consultants after 48 hours of the computer based antibiotic entry that the order would expire within hours. Telephone approval was obtained followed by a formal consultation if deemed necessary by the ID specialist or primary team. Antibiotic usage was standardized by defined daily doses (DDDs) per 1000/patient-days.


RESULTS
A cumulative 34% reduction was seen in the use of all broad spectrum antibiotics in our ICU after the enforcement of the antibiotic restriction policy. The largest reduction was seen in the use of Tazocin (190 DDDs) and Meropenem (60 DDDs). The policy resulted in a reduction by 40% of overall broad spectrum antibiotic pharmacy costs. The number of multidrug resistant organisms has remained static but the ventilator associated pneumonia rates have declined.


CONCLUSIONS
Streamlining the formulary to control antibiotic choices and the creation of a restriction program using the expertise of infectious disease physicians resulted in significant reductions in the use of and expenditure for broad spectrum antibiotics.
Siddiqui
Shahla
S
Department of Anaesthesia, Aga Khan University, Karachi.
Hussein
Kashif
K
Manasia
Roshan
R
Samad
Aijaz
A
Salahuddin
Nawal
N
Zafar
Afia
A
Hoda
M Qamarul
MQ
D000900:Anti-Bacterial Agents / Q000145:classification / Q000494:pharmacology / Q000627:therapeutic use*; D000077723:Cefepime; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use; D003906:Developing Countries; D011307:Drug Prescriptions / Q000592:standards*; D004352:Drug Resistance, Microbial; D017723:Drug Utilization Review; D006801:Humans; D015378:Imipenem / Q000494:pharmacology / Q000627:therapeutic use; D007362:Intensive Care Units / Q000592:standards*; D050316:Medical Order Entry Systems; D016134:Organizational Policy; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D010878:Piperacillin / Q000494:pharmacology / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011112:Polymyxin B / Q000494:pharmacology / Q000627:therapeutic use; D016730:Program Development; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077725:Piperacillin, Tazobactam Drug Combination; D014640:Vancomycin; D015378:Imipenem; D000077723:Cefepime; D010397:Penicillanic Acid; D011112:Polymyxin B; D010878:Piperacillin