title: Reserve drug indent form and its impact on antimicrobial consumption and sensitivity pattern in the medical intensive care unit of a tertiary care hospital.
abstract: OBJECTIVE
  A world without effective antibiotics is a terrifying but a real prospect. Overuse or misuse especially of newer and higher antimicrobials (AM) is of particular concern, as this contributes to development of resistance among microorganisms. To check this trend, the Reserve Drug Indent Form (RDIF) was introduced in our hospital and its impact on AM consumption, cost of therapy and the sensitivity pattern was studied in the medical intensive care unit (MICU).
  
  
  METHODS
  A retrospective descriptive study in the medical ICU of a tertiary care hospital from July 2012 to August 2013. From March 2013, RDIF was made mandatory to be filled up prior to prescribing reserve antimicrobials. AM consumption (expressed as DDD/100 bed days) and sensitivity pattern (expressed in percentage) six months prior to and six months after implementation of the form were analysed.
  
  
  RESULTS
  The total Reserve AM consumption was 125.79 per 100 bed days during the study period. Average occupancy index was 0.50 and length of ICU stay was 6 days. The total consumption reduced from 85.55/100 to 40.24/100 bed days after the introduction of the RDIF. However, Imipenem usage increased from 11.35/100 to 23.94/100 bed days, which can be attributed to sensitivity profile to Imipenem (82.1%) compared to Meropenem (65.7%). Cost of therapy reduced from Rs 6,27,951 to 4,20,469.
  
  
  CONCLUSIONS
  Reserve AM consumption showed a declining trend after introduction of the RDIF. Hence, the RDIF served as an important tool to combat inappropriate use, reducing the cost burden and also helped to improve the sensitivity to reserve drugs.
authors: Postgraduate, Department of Pharmacology, A.J. Institute of Medical Sciences and Research Centre , Mangalore, India .
authors: Deepthi P
authors: DP
authors: Shridhar
authors: Professor, Department of Microbiology & Co-ordinator HICC, A.J. Institute of Medical Sciences and Research Centre , Mangalore, India .
authors: K B
authors: KB
authors: Anitha
authors: Professor and Head, Department of Pharmacology, A.J. Institute of Medical Sciences and Research Centre , Mangalore, India .
authors: Mohandas
authors: M
authors: Rai
authors: Clinical Microbiologist (HICC), Department of Microbiology, A.J. Institute of Medical Sciences and research centre , Mangalore, India .
authors: Anisha
authors: A
authors: Fernandes
keywords: Antimicrobial Resistance; Daily defined dose; Reserve drug indent form; Sensitivity profile