[Prospective evaluation of the relevance of prescribing antibiotic combinations in an internal medicine department].
OBJECTIVE
To assess the relevance of antibiotic combinations according to available recommendations.


METHODS
Prospective monocentric study of 12-month duration in the department of internal medicine of a teaching hospital. All antibiotic combinations were assessed taking into account the infection type, the involved bacteria, the antibiotic nature, dosage and duration of treatment. A scientific committee classified each combination antibiotic therapy as: (1) in agreement with existing recommendations; (2) adapted to the antibiogram in the absence of available recommendations; (3) irrelevant but with no adverse clinical outcome for the patient; (4) irrelevant with potential adverse clinical outcome for the patient.


RESULTS
Among 87 antibiotic combinations prescribed, 67 (77%) agreed with available recommendations. The percentages of irrelevant combinations with and without potential adverse clinical outcome for the patient were 7% (six cases) and 16% (14 cases), respectively. Reasons for non-conformity included: (1) prescription of combination therapy while monotherapy could have been sufficient or antibiotic therapy was unjustified (14 cases); (2) prescribed antibiotics not adapted to antibiogram (three cases); (3) prescribed antibiotics not effective on the most likely bacteria when treatment of infection was empirical (three cases). The rate of prescription appropriateness was 97% when the mobile microbiology team had interfered with the decision, versus 53% (p<0.001) when it had not.


CONCLUSIONS
Seventy-seven percent of antibiotic combinations were appropriate and agreed with available recommendations. The advice of a microbiology team markedly improves this rate.
Caruba
T
T
Services de pharmacie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France. thibaut.caruba@egp.aphp.fr
Sabatier
B
B
Matta
M
M
Arlet
J-B
JB
Ranque
B
B
Capron
L
L
Mainardi
J-L
JL
Pouchot
J
J
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006748:Hospital Departments; D006801:Humans; D007388:Internal Medicine; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
D000900:Anti-Bacterial Agents