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Drug information (i. Anti-infectives, ii. cytostatics, iii. others)
Assessing the quality of antibiotic prescribing at discharge from hospital
  1. C. Marti Gil,
  2. D. Barreira Hernández,
  3. L. Martínez Valdivieso,
  4. G. Marcos Pérez,
  5. P. Llopis Salvia,
  6. D. Barreda Hernández
  1. 1Virgen de la Luz Hospital, Pharmacy Department, Cuenca, Spain

Abstract

Background Infectious diseases, mainly respiratory diseases, are one of the main reasons for hospital admissions. So an appropriate antibiotic prescription at discharge (APD) after these episodes of hospitalisation may have important clinical repercussions.

Purpose To assess the quality of APD.

Materials and methods Descriptive, observational, retrospective study over 3 months carried out in an Internal Medicine Short Stay Unit of a 400-bed hospital. It included patients discharged from an interdisciplinary medicines reconciliation program (June-August 2010). The authors reviewed all discharge information and collected data relative to demographics (sex, age), clinical picture (allergies, diagnosis), antibiogram (sample, microorganism isolated) and APD. To evaluate the quality of APD, The authors use these indicators: adherence to the Primary Care Pharmacotherapeutic Guide (PCPG), prescription by International Non-proprietary Name (INN), rate of prescription errors (PEs) (= (number of PEs/ total antimicrobial prescriptions)*100) and use (empirical/non-empirical). The authors considered the following to be PEs: mistakes in the dose/frequency/duration of treatment, omission of any of these or incomplete prescriptions.

Results 41.2% of patients were prescribed at least one antibiotic at discharge (n= 35, 5 of them with 2 antibiotics). Patient characteristics: 54% male, 75±13 years, 8 patients with a known history of drug allergies (4 to antibiotics such as penicillins, cephalosporins and/or fluoroquinolones). Amoxicillin-clavulanic acid was the most frequent antimicrobial agent prescribed (47.5%) and then, the third-generation cephalosporin cefditoren (17.5%) and the fluoroquinolone levofloxacin (17.5%). As to the clinical diagnosis, 71.4% of patients suffered respiratory infection (48% caused by COPD/asthma exacerbation). Microbiological cultures (sputum, blood, urine) were only assessed in 31.4% of the patients and half of them were positive, isolating a variety of microorganisms (Streptococcus viridans, Escherichia coli, Streptococcus pneumoniae, Haemophilus influenzae, Candida albicans, Aspergillus fumigatus, Morganella morganii, etc.). Regarding the quality of APD: 64.1% adhered to the PCPG, 24.4% prescribed by INN, PE rate=4.8%, 84.3% was empirical use.

Conclusions A review the use of antibiotics in hospital is a necessary tool to assess quality of prescription and to promote the rational use of drugs.

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