Original Article

Drug Utilization Evaluation of Agents Administered for Prevention and Treatment of Cancer-Related Infections


Backgrounds: Due to the critical role of antibiotics and increasing trend of resistance in developing countries, comprehensive methods of antibiotic use is necessary to limit the threat of resistant microorganisms. In this study we compare antibiotics consumption by Defined Daily Dose (DDD) per 100 bed-days in Shahid Ghazi hospitals during three months in Tabriz, Iran.Methods: This is a retrospective study, which enrolled patients with malignancy who admitted to Shahid Ghazi hospital from January till March 2016. From all, 58 patients diagnosed with malignancy and received antibiotics for prophylaxis and/or treatment. For the purpose of Drug Utilization Evaluation (DUE) all antibiotics, antifungals and antiviruses consumption for any reason (prophylaxis, empiric therapy, targeted therapy) were recorded. Data on administered medications such as indication, duration, and dose were compared according to the guidelines of the NCCN 2.2016. The accuracy of antibiotics consumption was assessing by NCCN (2.2016) guideline. Anatomical Therapeutic Chemical (ATC) code J01 was explained as defined daily doses per 100 bed-days (DDD/100) according to the ATC/DDD classification. The amount of consumption was assessed with DDD per 100 bed-days in three months. Results: from 56 patients, 46 of them had hematologic malignancy and 10 of them had solid tumors. The indication of antibiotics and antifungal prophylaxis were wrong in 19.6% of indications. The prophylaxis dosage of antibiotics, antifungal, antiviral and PCP were wrong in 8.8%, 41.7%, 80% and 50%, respectively. The prophylaxis duration of antibiotics, antifungal, antiviral and PCP were wrong in 69.4%, 61.2%, 80% and 100% respectively. The dose adjustment of antibiotics with GFR and renal status of patients, in 8 of 9 patients (88.88%) who received meropenem, and in 9 of 23 patients (39.13%) who received imipenem, were not applicable according standard guidelines. The total consumption of systemic antibiotics in Ghazi Hospital during 3 months was 5091From all patients 75% of them received antibiotics according to the ATC/DDD classification System. Conclusion: Specific strategies should be employed in infection control development and engage rational antibiotic utilization in order to reduce future resistant strains and increase anti-microbial efficacy.

1. Golkar Z, Bagasra O, Pace DG. Bacteriophage therapy: a potential solution for the antibiotic resistance crisis. J Infect Dev Ctries 2014;8(02):129-36.
2. Diekema DJ, BootsMiller BJ, Vaughn TE, et al. Antimicrobial resistance trends and outbreak frequency in United States hospitals. Clin Infect Dis 2004;38(1):78-85.
3. America IDSo. Bad bugs, no drugs. Available from: http://www idsociety org/pa/IDSA_Paper4_final_web pdf. 2004.
4. Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. PT 2015;40(4):277.
5. Luyt CE, Bréchot N, Trouillet JL, Chastre J. Antibiotic stewardship in the intensive care unit. Crit Care 2014;18(5):1-12.
6. Reimann HA, D’Ambola J. The use and cost of antimicrobics in hospitals. Arch Environ Health 1966;13(5):631-6.
7. Piddock LJ. The crisis of no new antibiotics—what is the way forward? Lancet Infect Dis 2012;12(3):249-53.
8. Rossolini GM, Arena F, Pecile P, Pollini S. Update on the antibiotic resistance crisis. Curr Opin Pharmacol 2014;18:56-60.
9. Lushniak BD. Antibiotic resistance: a public health crisis. Public Health Rep 2014;129(4):314-6.
10. Steinbach WJ, Marr KA, Anaissie EJ, et al. Clinical epidemiology of 960 patients with invasive aspergillosis from the PATH Alliance registry. J Infect 2012;65(5):453-64.
11. Zur Hausen H. Viruses in human cancers. Science 1991;254(5035):1167-73.
12. Parkin DM. The global health burden of infection‐associated cancers in the year 2002. Int J Cancer 2006;118(12):3030-44.
13. Hamishehkar H, Zoghi E, Chavoushi H, et al. Utilization evaluation of antimicrobial agents in neutropenic cancer patients in a teaching hospital: urgent of drug utilization evaluation studies. J Pharm Care 2014;2(1):3-9.
14. Mohammadzadeh M, Hatefi S, Reshadi N, Sanaat Z, Ghaffary S. Assessment of the Adherence Rate of Acute Chemotherapy Induced Nausea and Vomiting Prophylaxis Regimens by Medical Team to NCCN Clinical Recommendations: Cross-Section Observation. J Pharm Care 2021;9(1):24-30.
15. Hutchinson JM, Patrick DM, Marra F, et al. Measurement of antibiotic consumption: A practical guide to the use of the Anatomical Therapeutic Chemical classification and Defined Daily Dose system methodology in Canada. Can J Infect Dis 2004;15(1):29-35.
16. Goossens H, Ferech M, Vander Stichele R, Elseviers M, Group EP. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005;365(9459):579-87.
17. Baden LR, Swaminathan S, Angarone M, et al. Prevention and treatment of cancer-related infections, version 2.2016, NCCN clinical practice guidelines in oncology J Natl Compr Canc Netw 2016;14(7):882-913.
18. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2011;52(4):e56-e93.
19. Lindemulder S, Albano E. Successful intermittent prophylaxis with trimethoprim/sulfamethoxazole 2 days per week for Pneumocystis carinii (jiroveci) pneumonia in pediatric oncology patients. Pediatrics 2007;120(1):e47-e51.
20. Ramphal R, Gucalp R, Rotstein C, Cimino M, Oblon D. Clinical experience with single agent and combination regimens in the management of infection in the febrile neutropenic patient. Am J Med 1996;100(6):83S-9S.
21. Paul M, Yahav D, Fraser A, Leibovici L. Empirical antibiotic monotherapy for febrile neutropenia: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother 2006;57(2):176-89.
22. Bucaneve G, Micozzi A, Menichetti F, et al. Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. New Engl J Med 2005;353(10):977-87.
23. Leibovici L, Paul M, Cullen M, et al. Antibiotic prophylaxis in neutropenic patients: new evidence, practical decisions. Cancer 2006;107(8):1743-51.
24. Gafter-Gvili A, Fraser A, Paul M, Leibovici L. Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Intern Med 2005;142(12_Part_1):979-95.
25. Gea-Banacloche J. Evidence-based approach to treatment of febrile neutropenia in hematologic malignancies. Hematology Am Soc Hematol Educ Program 2013;2013(1):414-22.
26. Pagano L, Fianchi L, Mele L, et al. Pneumocystis carinii pneumonia in patients with malignant haematological diseases: 10 years' experience of infection in GIMEMA centres. Brit J Haematol 2002;117(2):379-86.
27. Roblot F, Le Moal G, Godet C, et al. Pneumocystis carinii pneumonia in patients with hematologic malignancies: a descriptive study. J Infect 2003;47(1):19-27.
28. von Lilienfeld-Toal M, Lehmann LE, Raadts AD, et al. Utility of a commercially available multiplex real-time PCR assay to detect bacterial and fungal pathogens in febrile neutropenia. J Clin Microbiol 2009;47(8):2405-10.
29. Vento S, Cainelli F. Infections in patients with cancer undergoing chemotherapy: aetiology, prevention, and treatment. Lancet oncol 2003;4(10):595-604.
30. Al-Hadithi D, Al-Zakwani I, Balkhair A, Al Suleimani YM. Evaluation of the appropriateness of meropenem prescribing at a tertiary care hospital: A retrospective study in Oman. Int J Infect Dis 2020;96:180-6.
31. Kabbara WK, Nawas GT, Ramadan WH. Evaluation of the appropriateness of imipenem/cilastatin prescription and dosing in a tertiary care hospital. Infect Drug Resist 2015;8:31-8.
32. Raveh D, Muallem-Zilcha E, Greenberg A, Wiener-Well Y, Schlesinger Y, Yinnon A. Prospective drug utilization evaluation of three broad-spectrum antimicrobials: cefepime, piperacillin-tazobactam and meropenem. QJM 2006;99(6):397-406.
33. Vazin A, Japoni A, Shahbazi S, Davarpanah MA. Vancomycin utilization evaluation at hematology-oncology ward of a teaching hospital in Iran. Iran J Pharm Res 2012;11(1):163.
34. Bahador L, Vazin A, Davarpanah MA, Arfa P. Carbapenems Utilization Evaluation in Neutropenic Patients of a Teaching Hospital. J Pharm Care 2019;7(4):106-111.
35. Sakhaiyan E, Hadjibabaie M, Gholami K, et al. Drug utilization evaluation of imipenem in patients undergoing bone marrow transplantation. Int J Hematol Oncol Stem Cell Res 2009;3(2):10-3.
36. Hartmann B, Czock D, Keller F. Drug therapy in patients with chronic renal failure. Dtsch Arztebl Int 2010;107(37):647.
37. Leo RJ, Ballow CH. Seizure activity associated with imipenem use: clinical case reports and review of the literature. DICP 1991;25(4):351-4.
38. Ghaffary S, Maleki TE, Abdollahpor J, Hamishehkar H. Measurement and comparison of inpatient antibiotic use in five different hospitals in Tabriz. Pharm Sci 2016;23(1):37-41.
39. Pešić G, Jović Z, Vasić K. Application of the atc/ddd methodology to compare antibiotic utilization in two university hospital surgical departments. Metabolism 2005;72:9.90.
IssueVol 9, No 3 (Summer 2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jpc.v9i3.7370
Drug Utilization Evaluation; Antibiotics; Hematologic Malignancy; Solid Tumor

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How to Cite
Mohammadzadeh M, Farashi E, Hesam AR, Chavoshi SH, Ghaffary S. Drug Utilization Evaluation of Agents Administered for Prevention and Treatment of Cancer-Related Infections. J Pharm Care. 2021;9(3):119-128.