Background and importance Misuse and abuse of antibiotics are among the main causes of the increase in antibiotic resistance. Monitoring and evaluation of antibiotic prescriptions is an important activity involving the hospital pharmacist.
Aim and objectives The aim of the study was to assess attitudes and practices towards antibiotics. The objectives were to assess clinical governance, prescriptive appropriateness as well as costs incurred.
Material and methods A retrospective observational study was carried out from 1 January 2017 to 31 December 2019 in a university hospital. Outpatient dispensing was used for patient identification and data collection. Demographic, diagnostic, therapeutic and clinical variables were gathered. Consumption was expressed as defined daily dose (DDD). Drugs evaluated were: tigecycline, ceftazidime and beta-lactamase inhibitor, meropenem, ertapenem, ceftaroline, fosamil, ceftolozane and beta-lactamase inhibitor, levofloxacin, dalbavancin, linezolid, daptomycin, amphotericin B, voriconazole, caspofungin, micafungin and anidulafungin. First dispensation date was considered as the index date. Custom requests (CR) that reported prescribing errors were considered inappropriate. Drug costs were calculated based on ex factory prices (VAT excluded), net of the temporary reductions provided for by law. Avoided costs were calculated based on inappropriate prescriptions and unauthorised treatments.
Results 4017 CR, 1267 patients (70.72% men; mean age 66.54 years) and 26 457.22 DDD (19.89 DDD/patient) were included in the study. The expenditure incurred was 1 214 876.87€. Data showed a significant decrease in the patient treated rate (−2%), DDD required (delta 2019–2017 = −9.33%) and expenditure incurred (delta 2019–17=−52.65%). The consumption (DDD/pz) of levofloxacin did not increase during the study period (mean 11.22 DDD/pz), while a considerable increase was highlighted for ceftaroline, fosamil and micafungin. Systemic antifungal therapy was started empirically in 181 patients (68.5% men; mean age 65 years). Daptomycin was used for persistent methicillin resistant Staphylococcus aureus bacteraemia (delta 2019–2018 = +191.43). 3.68% of CR (148/4017) were deemed inappropriate (56.4% in 2019). Costs saved were 29 730.37€. Prescribed daily dose represented the most common error (20.94%) in the CP examined.
Conclusion and relevance Hospital pharmacists detected and prevented harmful errors in prescribing therapies. Supervision by hospital pharmacists can significantly improve the management of clinical risk, patient safety, optimisation of care and effective management of expenditure.
References and/or acknowledgements
WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2014. http://www.whocc.no/atc_ddd_index/
Conflict of interest No conflict of interest