Impact of antibiotic restriction on broad spectrum antibiotic usage in the ICU of a developing country.

Abstract

OBJECTIVE: To reduce rates of nosocomial pneumonia and cost of antibiotic therapy. METHODS: By means of a policy implementation the following broad spectrum antibiotics were restricted to usage in the ICU for 72 hours: Cefepime, Meropenem, Imipenem, Tazocin, Polymixin B and Vancomycin, after an institutional based pharmacy and therapeutic committee approval. The ICU pharmacist would alert the ICU residents or consultants after 48 hours of the computer based antibiotic entry that the order would expire within hours. Telephone approval was obtained followed by a formal consultation if deemed necessary by the ID specialist or primary team. Antibiotic usage was standardized by defined daily doses (DDDs) per 1000/patient-days. RESULTS: A cumulative 34% reduction was seen in the use of all broad spectrum antibiotics in our ICU after the enforcement of the antibiotic restriction policy. The largest reduction was seen in the use of Tazocin (190 DDDs) and Meropenem (60 DDDs). The policy resulted in a reduction by 40% of overall broad spectrum antibiotic pharmacy costs. The number of multidrug resistant organisms has remained static but the ventilator associated pneumonia rates have declined. CONCLUSION: Streamlining the formulary to control antibiotic choices and the creation of a restriction program using the expertise of infectious disease physicians resulted in significant reductions in the use of and expenditure for broad spectrum antibiotics.