RESUMO
This study aimed to evaluate the prescribing practices and utilization of antimicrobials in a tertiary care teaching hospital of a Caribbean developing country. A prospective observational cohort study was undertaken for a period of 12 weeks in the general wards and the intensive care unit (ICU) of the hospital. Demographic data, diagnoses on admission, antimicrobials prescribed, dosage and duration, route of administration, leukocyte count and microbiological culture and sensitivity reports were recorded. Hospital length of stay and final outcome were recorded. The usage was determined in terms of prescribed daily dose and the total costs of antimicrobials were calculated. Of 889 patients admitted, 335 (37.7%) received 22 different antimicrobial drugs. Overall, 67% of the prescriptions adhered to the hospital protocol. Median length of stay in the hospital was 7 days. Skin and soft tissue infections were the most common diagnoses for which antimicrobials were prescribed. Amoxicillin-clavulanate was the most common (32%) antimicrobial used. Eighty-nine percent of the antimicrobials were given through the intravenous route. Sixty percent of the patients received two antimicrobials, 26% received three, and 14% of patients were prescribed four or more antimicrobials during their stay at the hospital. There was significantly higher inappropriate choice of antimicrobials in ICU when compared with general wards (Mantel-Haenszel Odds Ratio 3.3; 95% Confidence Intervals 1.4, 7.7). Prescribing patterns did not strictly adhere to the hospital antimicrobial protocol. There is a need for monitoring and control of antimicrobial prescription.
Assuntos
Produtos com Ação AntimicrobianaRESUMO
SUMMARY: Antimicrobial susceptibilities of 156 Streptococcus strains isolated from 1994 through 2002 were studied. Of this total, 38.7, 26.3, 16.7, 8.9, and 9.6 percent were recovered from patients with bacteremia, pneumonia, otitis media, sinusitis, and meningitis, respectively. All S. pneumoniae strains were fully susceptible to amoxicillin-clavulanic acid and ampicillin, with 9.0 and 2.6 percent being resistant to penicillin and ceftriaxone, respectively. The ratios of resistant strains to tetracyclin, co-trimoxazole, and chloramphenicol were 73.7, 69.3, and 63.5 percent, respectively. Approximately 90 percent of strains remain sensative to erythromycin. A high prevalence of resistance to penicillins cephalosporin does not exist in Trinidad, althought a trend towards that pattern seems to be developing. The most frequent serotype was 14(37.8 percent), followed by 6B(20.0 percent) , 23F(10.3 percent), and 4(6.4 percent), and all were recovered from children. The other serotypes accounted for <6 percent of the total isolates. All penicillin and ceftriaxone- resistant strains belonged to serotype 14 (MIC greater than or equal to 2 microg/ml and greater than or equal to 4 microg/ml), respectively. Identifiable risk factors for resistant isolates included the prevelance of otitis media and sinusitis among children treated inadequately with oral cephalosporins; the ease of obtaining antibiotics without a perscription at many pharmacies; and the indiscriminate perscribing of antibiotics by general practitioners.
