Epidemiologic observations of the judicious use of antibiotics in a pediatric teaching hospital

Abstract

OBJECTIVE: This study in a tertiary care teaching center with 361 beds was conducted to assess use, misuse, and abuse of antibiotics. MATERIALS AND METHODS: Every day of the study, a computer program was used to compile a list of patients' bedside records. On a specific day, the bedside charts of selected patients were reviewed to determine whether: (1) a justification for antibiotic prescription was recorded; (2) duration of antibiotic therapy had been defined; (3) suitable cultures had been obtained; and (4) treatment was appropriate for the infection to be treated. For 6 months, charts were evaluated 3 days per week. RESULTS: Of 750 bedside charts 500 (67%) were selected for review. Of the 500 patients, 175 (35%) did not receive antibiotics. The abuses or misuses of antibiotics most frequently observed among the 325 treated patients were no record of justification for the antibiotic prescribed (130/325, 40%); no appropriate blood or fluid samples obtained for culture (45/325, 14%); no subsequent control cultures or cultures obtained before modifying therapy (80/175, 46%); no indication of a planned duration of therapy (180/325, 55%); and improper dosage prescribed in relation to weight (25/325, 8%). Abuse or misuse of antibiotics was more frequently observed among surgical patients than among nonsurgical patients (P<0.05). CONCLUSION: Rational use of antibiotics should be emphasized in every training program as a main strategy to control the increase in drug resistance and to prolong the usefulness of antibiotics.