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IntroductionCephalosporins are amongst the most commonly used antibiotic in hospital settings worldwide. Hospital Queen Elizabeth II (HQEII) was the highest user nationwide for this and in 2018, the antibiotic report collated by the Pharmacy Department of HQEII reflected high usage of third-generation cephalosporins in medical wards. ObjectivesTo identify: The indication(s) of third-generation cephalosporins in medical wards at Hospital Queen Elizabeth II. The dosing regimen appropriateness (dose,frequency and duration) as accordance to the National Antibiotic Guideline (NAG) 2019. MethodsA prospective, observational study was conducted in general medical wards HQEII from June 2019 - January 2020. • Inclusion criteria: Adults patients who were prescribed with third-generation cephalosporins (ceftazidime, ceftriaxone, cefotaxime, cefoperazone/sulbactam). • Parameters of interests: Demographic, indication , antibiotics regimen and duration and relevant laboratory parameters. ResultsTotal of 137 patients recruited. Patients’ demographic was displayed in Table 1.Respiratory tract infection (n=54, 39.4%) was the most common diagnosis by system. Median duration of antibiotics prescribed was three days (Interquartile range=3).Due to the prevalent of melioidosis in Sabah, ceftazidime was often prescribed for empirical therapy of melioidosis (n=64, 75.3%), especially in patients presented with risk factors such as diabetes mellitus (n=40,62.5%), chronic kidney disease (n=27, 42.2%) and occupational exposure (n=4, 6.25%). Only 13 patients (15.3%) turned out to be positive melioidosis. The mean duration for empirical therapy of melioidosis was 3 + 1.6 days. It was observed that most review of ceftazidime was carried out within 72 hours of antibiotic initiation in which this is comply with the inhouse Antimicrobial Stewardship Policy of HQEII. ConclusionOverall, third-generation cephalosporins were appropriately prescribed in medical wards as per NAG 2019. However, further exploration on the usage of ceftazidime in empirical melioidosis is warranted. |
