Prospective Drug Use Evaluation of Meropenem in a Teaching Referral Hospital, Mashhad, Iran

  • Fatemeh Naseri Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
  • Nasser Vahdati-Mashhadian Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 3 Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Mohammad Reza Saberi Medical Chemistry Department, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
  • Amir Hooshang Mohammadpour Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, IranPharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Sepideh Elyasi Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, IranPharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Keywords: Drug use evaluation, Meropenem, Antibiotic administration, Infection, Medication error

Abstract

Introduction: Inappropriate use of antibiotic, leads to microbial resistance, nosocomial infections and increased hospital costs. Therefore, it is necessary to control and evaluate the use of these medications, especially broad-spectrum antibiotics. This study evaluated the pattern of meropenem utilization in Imam Reza hospital, Mashhad, Iran.Methods: First, a guideline for proper indications of meropenem was designed and finalized based on the clinical pharmacists and infectious disease specialist’s comments. One hundred patients were chosen randomly from different wards of the hospital and their data were recorded in predesigned questionnaires. Then, the pattern of meropenem consumption was analyzed according to the guideline.Results: This study was performed in 100 patients, including 48 women and 52 men. In 13 cases (13%), patients had no approved indication for meropenem. The initial regimens were changed in 6 cases (6%) based on culture results and in 73 cases (73%) relied on clinical response. In 64 cases (64%), administrated doses were compatible with prepared guideline. Renal dose adjustment was acceptable based on guideline only in 30% of patients with renal impairment (30 patients out of 100). Hyper-sensitivity reaction, one of the adverse reactions of meropenem, was seen in 1 patient (1%).Conclusion: According to the results, considerable errors occurred in meropenem administration and dosing. Therefore, it is necessary to design and implement a localized guideline for meropenem consumption in Imam Reza hospital of Mashhad, Iran.

References

A World Health Organization. Drug and Therapeutics Committees: A Practical Guide. WHO website 2003 [cited 2017 January 9]; Available from: URL:http://apps.who.int/medicinedocs/en/d/Js4882e/8.5.html.

.Mahini S, Hayatshahi A, Torkamandi H, Gholami K, Javadi M.R. Carbapenem utilization in critically ill patients. J Pharm Care 2013; 1(4):141-4.

Erbay A, Colpan A, Bodur H, Cevik MA, Samore MH, Ergonul O.Evaluation of antibiotic use in a hospital with an antibiotic restriction policy.Int J Antimicrob Agents 2002; 21:308-12.

A World Health Organization. Drug and Therapeutics Committees: APractical Guide. WHO website 2003 [cited 2017 January 9]; Available from:URL: http://apps.who.int/medicinedocs/en/d/Js4882e/10.1.html.

Kabbara WK, Nawas GT, Ramadan WH. Evaluation of the appropriatenessof imipenem/cilastatin prescription and dosing in a tertiary care hospital.Infect Drug Resist 2015; 8:31-38.

Mcevoy GK, Snow EK, Miller J, Kaster L, Heydorn JD. AHFS druginformation. USA: Bethesda; 2016. p. 166-70.

Doi Y, Chambers HF. Other β-Lactam Antibiotics. In: Bennett JE, Dolin R,blaster MJ, editors. Mandell, Douglas and Bennett’s principles and practiceof infectious diseases. 8thed. Vol 1. 2015. p. 293-6.

Shiva A, Salehifar E, Amini M, Ala S, Rafati MR, Ganji R. Drug utilizationevaluation of Imipenem in an educational hospital in Mazandaran province.Pharm Sci 2014; 20:12-17.

UPTODATE. Meropenem drug information. UPTODATE website 2017[cited 2017 January 11]; Available from: URL:https://www.uptodate.com/contents/meropenem-drug-information?source=see_link.

Anonymus. The Sanford guide to antimicrobial therapy 2013. 43th ed. USA:Antimicrobial therapy; 2013. p. 40-1.

Anonymus. Drug facts and comparisons. VOL ΙΙΙ. USA: Wolters KluwerHealth. Philadelphia: Saunders; 2016. P. 2242-3.

Bauer LA. Applied clinical pharmacokinetics. 3rd ed. USA: McGraw –Hill; 2014. p. 200-5.

Sumret W, Saowakul K, Haephruek T, Pengsombat P, Kwanmuang W.Evaluation of meropenem use among septic patients at Hua Hin hospital,Thailand. Silpakorn U Science & Tech J 2016; 10(1): 21-26.

Farzad BF, Hadavand N, Salehi H, Shekari M. Carbapenems, Linezolid,Teicoplanin utilization evaluation in a large teaching based hospital (ShahidRajaie heart center, Tehran): a quality improvement study. Biomed &Pharmacol J 2016; 9:525-32.

Vessal G, Namazi S, Davarpanah MA, Foroughinia F. Evaluation ofprophylactic antibiotic administration at the surgical ward of a major referralhospital, Islamic Republic of Iran. East Mediterr Health J 2011; 17:663-8.

Ozkurt Z, Erol S, Kadanali A, Ertek M, Ozden K, Tasyaran MA. Changesin antibiotic use, cost and consumption after an antibiotic restriction policyapplied by infectious disease specialists. Jpn J Infect Dis 2005; 58:338-43.

Pestotnik SL, Classen DC, Evans RS, Burke JP. Implementing antibioticpractice guidelines through computer-assisted decision support: clinical andfinancial outcomes. Ann Intern Med 1996; 124:884-90.

Salehifar E, Shiva A, Moshayedi M, Samiei Kashi T, Chabra A. Drug useevaluation of Meropenem at a tertiary care university hospital: a report fromNorthern Iran. J Res Pharm Pract 2015; 4:222-5.

Hecker MT, Aron DC, Patel NP, Lehmann MK, Donkey Curtis. Unnecessaryuse of antimicrobials in hospitalized patients. Arch Intern Med 2003;163:972-8.

Khan MU, Yousuf RI, Shoaib MH. Drug utilization evaluation ofmeropenem and correlation of side effects with renal status of patients in ateaching based hospital. Pak J Pharm Sci 2014; 27:1503-8.

Mousavi S, Behi M, Taghavi MR, Ahmadvand A, Ziaie S, Moradi M.Drug utilization evaluation of Imipenem and intravenous ciprofloxacin in ateaching hospital. Iran J Pharm Res 2013; 12:161–7.

Norrby SR, Gildon KM. Safety profile of Meropenem: a review of nearly5000 patients treated with Meropenem. Scand J Infect Dis 1999; 31:3-10.

Published
2018-05-13
How to Cite
1.
Naseri F, Vahdati-Mashhadian N, Saberi MR, Mohammadpour AH, Elyasi S. Prospective Drug Use Evaluation of Meropenem in a Teaching Referral Hospital, Mashhad, Iran. jpc. 5(1-2):2-.
Section
Original Article(s)