Background Linezolid is a broad-spectrum antibiotic active against gram-positive bacteria and its use must be controlled. The definite daily dose (DDD) is a statistical measure of drug consumption: the assumed average maintenance dose per day for a drug used for its main indication in adults. In June 2014, the hospital was transferred to the new utilities and e-prescribing, with clinical decision support systems implemented.
Purpose To quantify and analyse the use of linezolidand and its cost, after a hospital transfer and e-prescribing implementation.
Material and methods Observational, retrospective study of linezolid usage from January 2013 to December 2016. We established two study periods: pre-transfer and post-transfer. Oral linezolid (suspension and tablets) and intravenous (IV) doses dispensed were reviewed in hospitalisation units (HU) and intensive care units (ICU). Data were obtained from Pharmacy Management Application: the number of doses dispensed and their cost. We determined the number of DDD/100 stays using a linezolid DDD value of 1.2 g (600 mg/12 hour).
Results During the pre-transfer period a total of 6310 doses were dispensed for the HU (mean of 350 per month): 69.27% IV, 30.52% tablets, 0.21% suspension. In the ICU 3,236 units (179 units/month): 92.49%, 7.23% and 0.28%, respectively. The total cost was €549,954.6 (€30,553.03/month). During the post-transfer period: a total of 29 239 doses were dispensed for the HU (mean of 974 per month): 36.67% IV, 63.08% tablets, 0.25% suspension. In the ICU 4,931 units (164 per month): 92.94%, 7.00% and 0.06%, respectively. The total cost of linezolid was €1,968,369.75 (€65,612.33/month). The number of DDD/100 stays for linezolid in the HU was 0.99 (2013), 1.21 (2014), 2.33 (2015) and 2.49 (2016) and in the ICU: 7.73 (2013), 8.1 (2014), 8.1 (2015) and 7.9 (2016).
Conclusion After the transfer, linezolid usage has increased (x3) in the HU, remaining stable in the ICU. The number of DDD/100 stays confirms these results. In the HU there was an increase in the use of oral versus parenteral linezolid. This may be related to the inclusion of sequential therapy protocols as clinical decision support systems in the computerised provider order entry, after the hospital transfer. DDD/100 stays is a valid and useful indicator to quantify the use of antibiotics and identify usage changes, and it is used frequently in antimicrobial stewardship programmes. A deeper analysis is needed to identify the causes of the increase inuse of linezolid and to implement measures to control it.
References and/or acknowledgements No conflict of interest.
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