title: Agreement on the prescription of antimicrobial drugs.
abstract: BACKGROUND
  There is universal awareness of the difficulties faced by doctors when prescribing antimicrobials.
  
  
  METHODS
  Over a six-month period patients hospitalized in the ICU and under treatment with antibiotics and/or antifungals were eligible to participate in the study. The data were assessed by two infectious diseases specialists. Once completed, all case forms were sent independently to both evaluators (TZSC and ARM) by e-mail. Based on the data received, the evaluator completed a form automatically generated on the e-mail and returned it to the original mailbox for further analysis. We assessed the level of agreement between infectious disease specialists and the physicians directly responsible for the decision to begin antimicrobial therapy, as well as to assess the appropriateness of the regimen prescribed.
  
  
  RESULTS
  Among the antimicrobial regimens prescribed to the 177 patients, 36% were considered inappropriate by specialist #1 and 38% were considered inappropriate by specialist #2. We found 78% agreement by at least one of the infectious disease specialists with the prescribed antimicrobial regimen, and in 49% of cases both specialists agreed with the prescribed regimen. Both disagreed with the prescribed regimen in 22% of the cases and they disagreed between themselves in 29% of the cases.
  
  
  CONCLUSIONS
  This study highlights the difficulties in prescribing effective empirical antimicrobial therapy--they are of such magnitude that even two specialists in infectious diseases, well acquainted with our hospital's resistance patterns and our patients' profiles have considerable disagreement.
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. eduardo.casaroto@einstein.br.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Casaroto
authors.affiliation: Division of Medical Practice, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - 1st floor - Bloco A1 - Room 108 Morumbi, 05651-901, São Paulo, Brazil. alexandre.marra@einstein.br.
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. thiago.zinsly@einstein.br.
authors.forename: Thiago Zinsly Sampaio
authors.initials: TZ
authors.lastname: Camargo
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. ana.souza@einstein.br.
authors.forename: Ana Rita Araújo
authors.initials: AR
authors.lastname: de Souza
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. carlos.almeida@einstein.br.
authors.forename: Carlos Eduardo Saldanha
authors.initials: CE
authors.lastname: de Almeida
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. elizia.pedroti@einstein.br.
authors.forename: Elizia Piassi
authors.initials: EP
authors.lastname: Pedroti
authors.affiliation: Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil. elivane.victor@einstein.br.
authors.forename: Elivane da Silva
authors.initials: Eda S
authors.lastname: Victor
authors.affiliation: Division of Medical Practice, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - 1st floor - Bloco A1 - Room 108 Morumbi, 05651-901, São Paulo, Brazil. oscar@einstein.br.
authors.forename: Oscar Fernando Pavão
authors.initials: OF
authors.lastname: dos Santos
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. michael-edmond@uiowa.edu.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
authors.affiliation: Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil. alexandre.campos@einstein.br.
authors.forename: Alexandre Holthausen
authors.initials: AH
authors.lastname: Campos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003141:Communicable Diseases / Q000188:drug therapy; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents