Prospective surveillance of daptomycin and intravenous colistin use after implementation of new guidelines
| Autor: | Laurence Senn, Giorgio Zanetti, Catherine Plüss-Suard, J. Devaud |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class business.industry Antibiotics Pharmacy biochemical phenomena metabolism and nutrition bacterial infections and mycoses Loading dose Antibiotic resistance medicine Colistin Vancomycin lipids (amino acids peptides and proteins) Pharmacology (medical) Daptomycin Medical prescription Intensive care medicine business medicine.drug |
| Zdroj: | Le Pharmacien Hospitalier et Clinicien. 50:330-331 |
| ISSN: | 2211-1042 |
| DOI: | 10.1016/j.phclin.2015.07.045 |
| Popis: | Introduction Antimicrobial restriction is an effective strategy to control antibiotic use and limit the spread of bacterial resistance [1] , [2] . Due to the progressive increase in daptomycin and intravenous colistin use in our hospital, local guidelines were implemented in 2013. Objective We aimed to evaluate the appropriateness of daptomycin and intravenous colistin prescriptions according to new guidelines. Method We performed a prospective observational study by reviewing all prescriptions of daptomycin (09/2013–01/2015) and intravenous colistin (01/2014–01/2015). We used specific order forms received at the pharmacy to identify prescriptions. Clinical and bacteriological data were retrieved from patients’ electronic charts. Antimicrobial appropriateness was appraised according to guidelines: accepted indications and dosage for both antibiotics, follow up of creatine kinase (CK) levels for daptomycin and use in combination therapy for intravenous colistin. Results In total, 25 daptomycin and 18 intravenous colistin prescriptions were evaluated. Of the 25 daptomycin prescriptions, 21(84%) met the accepted indications: 10 cases planned for outpatient parenteral antibiotic therapy (OPAT), 7 cases of severe allergy to vancomycin, 2 MRSA bacteremia/endocarditis not responding to vancomycin, 2 vancomycin-induced nephrotoxicity. Two (8%) prescriptions did not meet accepted indications but were nevertheless considered justified. Only 2 (8%) prescriptions were considered unjustified. Dosage was adequate in 92% of patients and CK levels were followed up in 88%. Orders were validated by infectious diseases (ID) specialists in 92% of cases. Of the 18 intravenous colistin prescriptions, 17 (95%) met the accepted indications. 12/18 (63%) dosages were adequate; 6 (32%) were not because of lack of loading dose in cystic fibrosis patients or lack of adaptation to renal function. Another antibiotic was associated in 100% of cases. Orders were validated by ID specialists in 8/18 cases (44%). Discussion This prospective surveillance allowed us to observe that the appropriateness of prescriptions of 2 restricted antibiotics was satisfactory. Dosages for intravenous colistin in cystic fibrosis patients will be reevaluated. The collaboration between the pharmacy and the antibiotic stewardship team is needed as the number of restricted antibiotics tends to increase. |
| Databáze: | OpenAIRE |
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