Use of antibacterial drugs in Jesenice General hospital in years 1998 to 2004

Abstract

Background: Continuous monitoring of drug consumption is an important strategy for prudent and cost-effective use of drugs. Antimicrobials are among the most prescribed drugs in outpatient practice and in hospital care. In most cases antimicrobials are improperly prescribed or are even misused. Irrational use of antimicrobials is clinically ineffective and leads to higher treatment costs. Clinical ineffectiveness due to irrational use additionally leads to loss of confidence in antimicrobial drugs, unnecessary exposure of patients and development of antimicrobial resistance. Antimicrobial resistance has become a major global health problem as it presents an imperative for development of new potent antimicrobials which are necessarily associated with markedly higher treatment costs.

Material and methods: This survey was focused on rational prescribing of antimicrobial drugs. The data on consumption of antimicrobials for various clinical departments of the Jesenice General Hospital were collected by the hospital pharmacy. WHO ATC 2005 classification system, which ranks antimicrobials in a large group J01: drugs for systemic treatment of bacterial infections and Defined Daily Dose as a measuring unit according to the WHO ATC/DDD methodology was used. Antimicrobial use at the Jesenice General Hospital in the period between 1998 and 2004 was estimated by the Department of Infectious Diseases, Medical Centre Ljubljana as a part of European Surveillance on Antibiotic Consumption project (ESAC). Statistical part of survey was performed by the Chair of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana.

Results: After year 2000 a trend of decrease in antimicrobial consumption was observed. Compared to European Surveillance on Antibiotic Consumption results in the year 2003 higher usage of penicillins with extended spectrum, fluoroquinolones and 3rd generation cephalosporins in Slovenian hospitals was estimated. These three groups of antimicrobials were also among the most frequently prescribed antimicrobials at the Jesenice General Hospital. However, the increase of their use during the observation period in our study was not significant. On the other hand significant decrease in consumption of cephalosporins was observed in correlation with increased consumption of aminoglycosides. According to the observed proportions of various antimicrobial groups in the total consumption of the ATC group J01 drugs, it can be concluded that their prescribing was appropriate for empirical treatment, especially since the use of second-line antimicrobials (glycopeptides, carbapenems and 4th generation cephalosporins) was low.

Conclusions: At the Jesenice General Hospital combinations of penicillins with beta-lactamase inhibitors are still overused and should be replaced with the increased empirical prescribing of amoxicillin or ampicillin when possible. Additionally, de-escalation methodology of empirically prescribed wide spectrum antimicrobials according to antibiotic susceptibility results of isolated bacteria should be improved. 2nd generation instead of 3rd generation cephalosporins should be used preferentially whenever possible, especially in cases of switching to peroral antimicrobial treatment. In the future continuous participation in the European Surveillance on Antibiotic Consumption project should be assured and according to its results appropriate strategy of prudent antimicrobials use at the Jesenice General Hospital should be developed.