Drug Utilization Evaluation of Two Broad-Spectrum Antimicrobials: Cefepime and Piperacillin/Tazobactam in a Teaching Hospital in Tabriz, Iran

  • Parviz Saleh 1Infectious and Tropical Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
  • Hadi Hamishekar Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran AND Department of Clinical Pharmacy, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
  • Farnaz Naeimzadeh 3Department of Clinical Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
  • Sara Mikaili Department of Clinical Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
  • Hamid Owaysee Osquee Department of Infectious Diseases, School of Medicine, Tabriz university of Medical Sciences, Tabriz, Iran
  • Haleh Rezaee Infectious and Tropical Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran AND Department of Clinical Pharmacy, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
Keywords: Piperacillin/Tazobactam, Cefepime, Drug Utilization Evaluation

Abstract

Background: The inappropriate use of antibiotic leads to microbial resistance, nosocomial infections and increased hospital costs. The broad-spectrum antibiotics, such as cefepime and piperacillin/tazobactam play an important role in the empiric therapy of serious infections.

Methods: Demographic data, duration of prescription, dose, dosage adjustment in renal impairment and accompanied prescribed antibiotics were extracted from medical files. UpToDate and AHFS drug information 2012 were considered as standards of rational prescribing. Data analysis was performed by SPSS 18 software. Results: Drug dosage and indication were appropriate in 16 (23%). The most common antibiotic administered with cefepime was ciprofloxacin (37 cases). In 21 patients, cefepime dosage should have been adjusted according to renal impairment, whereas it has done only in 16 (22.9%) patients. Culture was done in 60 (85.8%) cases. Culture ordered before starting of antibiotics took place in 3(4.2%) patients. In 22(31.4%) patients, the result of culture was negative. Drug dosage and indication were appropriate in 34 (48%). The most common antibiotic administered with tazocin was vancomycin (45 cases). In 9 patients, tazocin dosage should have been adjusted according to renal impairment and it has done. Culture was done in 53 (75.8%) cases. Culture ordered before starting of antibiotics took place in 6(8.57%) patients. In 9(12.8%) patients, the result of culture was negative.

Conclusion: The results showed that there was an injudicious use of cefepime and piperacillin/tazobactam at our hospital, evidenced by the significant number of inappropriate empiric prescriptions and drug modifications

References

1. Shoaei S, Bagherzadeh A, Haghighi M, Shabani M. Vancomycin and Five Broad-spectrum Antibiotic Utilization Evaluation in an Educational Medical Center in One Year. J Pharm Care 2015;2(4):154-61.
2. Vaughan L., Wise K., Holmes-Maybank K., Charity P. Antibiotic resistance threats in the United States, 2013. Centers for Disease Control and Prevention. 2013.
3. Ayinalem GA, Gelaw BK, Belay AZ, Linjesa JL. Drug use evaluation of ceftriaxone in medical ward of Dessie Referral Hospital, North East Ethiopia. Int J Basic Clin Pharmacol 2017;2(6):711-7.
4. Slama T, Amin A, Brunton S. A clinician’s guide to the appropriate and accurate use of antibiotics: the Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria. Am J Med 2005;118(7A):1S-6S.
5. Erbay A, Çolpan A, Bodur H, Çevik MA, Samore MH, Ergönül Ö. Evaluation of antibiotic use in a hospital with an antibiotic restriction policy. Int J Antimicrob Agents. 2003;21(4):308-12.
6. Raveh D, Muallem-Zilcha E, Greenberg A, Wiener-Well Y, Schlesinger Y, Yinnon AM. Prospective drug utilization evaluation of three broad-spectrum antimicrobials: cefepime, piperacillin-tazobactam and meropenem. QJM
2006;99(6):397-406.
7. Lei J, Wang Y. Cefepime. World Pharm 1996;17:354–8.
8. Lu H, Weng X, Pang M. Phase IV trials of cefepime in treat-ment of various moderate or severe bacterial infections. Chin J New Drugs Clin Remedies 2002;21:268-70.
9. Young M, Plosker G. Piperacillin/tazobactam: a pharmacoeconomic review of its use in moderate to severe bacterial infections. Pharmacoeconomics 2001;19(11):1135-75.
10. Brodie D, Smith W, Hlynka J. Model for drug usage review in a hospital. Am J Hosp Pharm 1977;34:251.
11. Terry AK, Draugalis JR, Bootman JL. Drug-use evaluation programs in short-term-care general hospitals. Am J Hosp Pharm 1993;50(5):940-4.
12. Cefepime: Drug information [Available from URL: http://www. uptodate.com/contents/cefepime-drug-information?source=search_result&search=cefepime&selectedTitle=1~75.
13. Piperacillin and tazobactam sodium: Drug information [Available from URL: http://www.uptodate.com/contents/piperacillinand-tazobactam-sodium-drug- informat ion?source=search_result&search=tazocin&selectedTitle=1~81.
14. Hossain DM, Panda AK, Chakrabarty S, et al. MEK inhibition prevents tumour-shed transforming growth factor-beta-induced T-regulatory cell augmentation in tumour milieu. Immunology 2001; 144:561-73.201.
15. Kollef MH. Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis 2000;31(S131-S138).
16. Meakins M, Jonathan L, Byron J, Masterson R. Prevention of postoperative infection. ACS Surgery: Principles and Practice 2004:26-35.
17. Khan FY, Elhiday A, Khudair IF, et al. Evaluation of the use of piperacillin/ tazobactam (Tazocin) at Hamad General Hospital, Qatar: are there unjustified prescriptions? Infect Drug Resist 2012;5:17-21.
Published
2019-08-31
How to Cite
1.
Saleh P, Hamishekar H, Naeimzadeh F, Mikaili S, Owaysee Osquee H, Rezaee H. Drug Utilization Evaluation of Two Broad-Spectrum Antimicrobials: Cefepime and Piperacillin/Tazobactam in a Teaching Hospital in Tabriz, Iran. J Pharm Care. 7(1-2):21-25.
Section
Original Article(s)