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5PSQ-054 Evaluation of an application to help for the adequacy of the dosage of antibiotics in renal failure
  1. Q Moreno1,
  2. P Alonso1,
  3. N Sala1,
  4. S Cervera2
  1. 1Hospital Sant Joan de Déu. Fundació Althaia, Pharmacy, Manresa, Spain
  2. 2Hospital Sant Joan de Déu. Fundació Althaia, Information Systems, Manresa, Spain


Background and Importance Due to the aging of the population, there are more and more patients with chronic renal failure who require prolonged hospitalisation. There are also many patients who, during a hospital admission, see their renal function worsen and are therefore candidates for a dosage adjustment of certain drugs.

For this reason we designed within our drug prescription system, a module to guarantee safety in the prescription of drugs that require adjustment according to glomerular filtration rate (GFR).

Aim and Objectives To improve the safety of prescribing antibiotics requiring renal adjustment during hospital admission.

Material and Methods In the drug prescription system we can indicate the recommended dosage according to the GFR interval of each drug.

If from a certain GFR, its prescription is not recommended, the program warns you and advises against its use.

Different GFR intervals can be added and if necessary a different dose of the same drug can be associated. Thus, when the program alerts that the drug requires a change of dose, the program proposes it automatically, which entails agility at the time of making the prescription.

Within the prescription program, the value of the patient‘s last GFR can be displayed with the date of the analysis. It is with this value that the program makes the proposal to change the dosage.

If dosage adjustment is not necessary according to clinical criteria, the conventional regimen can also be prescribed.

Results During the 4 years after implantation, 28,701 dosage adjustments have been made according to renal function. Of these, 6,081 (21%) correspond to antibiotics.

Of the total dosages changed, 1,410 (23%) correspond to piperacillin-tazobactam, 1,138 (18.7%) to ciprofloxacin, 822 (13.5%) to amoxicillin-clavulanic acid, 380 (6.2%) to meropenem, 330 (5.4%) to levofloxacin, 183 (3%) to fosfomycin, 176 (3%) to cefepime, 163 (2.6%) to imipenem, 160 (2.6%) to cefazolin, 141 (2.3%) to vancomycin and 139 (2.2%) to ceftriaxone.

The remaining 1,039 (17%) antibiotics carry the remaining 1,039 (17%) prescriptions.

Conclusion and Relevance This application has helped us to improve the adequacy of the dosage of antibiotics in case of renal failure.

Conflict of Interest No conflict of interest.

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