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General and Risk Management, Patient Safety (including: medication errors, quality control)
Tigecycline prescribing in Salerno University Hospital: special forms and monitoring prevent inappropriate use
  1. N. Ciociano,
  2. M. Pacillo,
  3. F. Romano,
  4. M. Alfieri,
  5. G.M. Lombardi,
  6. M.G. Elberti,
  7. L. Grisi
  1. 1Università degli Studi di Salerno, Scuola di Specializzazione in Farmacia Ospedaliera, Fisciano (Salerno), Italy
  2. 2Azienda Ospedaliera Universitaria ‘S.Giovanni di Dio e Ruggi d’Aragona’, Farmacia Interna, Salerno, Italy

Abstract

Background Antibiotic resistance is an emerging and alarming problem in the European Union, considering the high clinical and socio-economic costs, and confirms the widespread inappropriate use of antibiotics. Tigecycline is a semisynthetic glycylcycline bacteriostatic that received approval for the treatment of skin, soft-tissue and intra-abdominal infections. Tigecycline operates by binding the bacterial 30S ribosomal subunit and it is highly active against a wide range of clinically important Gram-positive and Gram-negative aerobic bacteria and anaerobes.

Purpose The aim of this study was to evaluate tigecycline prescribing in Salerno University Hospital by analysis of the special forms introduced in 2010 to limit the inappropriate use of this antibiotic.

Materials and methods The hospital pharmacy supplies tigecycline on receipt of a completed antibiotic monitoring form. Forms from 2010 were retrospectively assessed for appropriate prescribing, adherence to permitted indications and length of treatment. The monitoring form contains patient details in one section and another part relates to diagnosis, site of the infection and the main reason for tigecycline use. A discussion with a microbiologist or infectious diseases physician is required when tigecycline is not prescribed for its permitted indications. The 2010 data were compared with data from 2009, when a non-specific antibiotic form was used.

Results A total of 220 requests were received in 2010. Intensive care unit (38%), infectious diseases unit (21%), general surgery division (10%) and emergency surgery division (20%) made the highest number of requests for tigecycline; 11 were incomplete. Many gaps (20%) were observed in the diagnosis and period of treatment fields. A pharmacist discussed the off-label use of tigecycline with a microbiologist in seven cases. These results, compared with the 2009 data, showed a general reduction of 30% in inappropriate requests for, and use of, tigecycline.

Conclusions A tigecycline-specific form is an effective tool of clinical governance with which hospital pharmacists can control and decrease the risk of inappropriate antibiotic treatment and development of resistance. The reduction in inappropriate requests confirms this, but the gaps in diagnosis and length of treatment data suggest physicians need more education on the correct use of the form. Moreover this monitoring form could contribute to containing the pharmaceutical costs and it should be extended to other expensive drugs used inappropriately in the hospital.

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