1、Clinical Audit of the Use of Antibiotics in Acute Medical Wards,Dr. Chan Kai Ming Microbiology / Infectious Disease Team Department of Pathology / Department of Medicine & Geriatrics Tuen Mun Hospital,Background,Appropriateness in use of antibiotics directly affect the quality of care of patients. P
2、atient care Morbidity Mortality Restriction in use Minimization of emergence of resistant strains,Objectives,Audit the use of antibiotics in the following aspects Initiation of the use of antibiotics Choice of initial & subsequent antibiotics Duration of antibiotics Dose of antibiotics Route of admi
3、nistration,Standards,No international set criteria available for reference. Ideal situation 100% appropriateness in the antibiotic use for all patients Set standard 80%,What is appropriate?,Initiation of antibiotics Choice of antibiotics Duration/ dosage/ route of administration of antibiotics,Crite
4、ria for appropriate initiation of antibiotics,Empirical treatment/ clinical evidence/ suspicions on active infection Clinical sepsis Fever, raised white cell count Chills and rigors Signs and symptoms of active infection consolidation of lung segment etc.,Criteria for appropriate initiation of antib
5、iotics,Prophylactic therapy For example Prepare for procedures/ operation in underlying valvular heart diseasePre-emptive therapy For example Leukemic patient started on chemotherapy Anti-CMV treatment for transplant patient,Criteria for appropriate choice of antibiotics,Prescription of antibiotics
6、in accordance to available guidelines Depends on diagnosis made Good guess of possible pathogen Change of antibiotics according to microbiological results Culture result Serological test etc.,Criteria for appropriate choice of antibiotics,Change of antibiotics according to clinical progress Suboptim
7、al response to current antibiotics therapy Individual Allergy to antibiotics,Criteria for appropriate duration/ dosage/ route of administration of antibiotics,According to guidelines According to clinical progress According to pharmacokinetic/ pharmacodynamic properties,Data collection and analysis,
8、Objective observation on the management of patients. Period 7th July 2004 to 12th July 2004 All acute admission to one male ward and one female ward Daily assessment done on the management of individual patient till discharge, transferred out or a maximum duration of seven days,Three steps,Initiatio
9、n of antibiotics Choice of antibiotics Duration/ dosage/ route of administration of antibiotics,106 admissions, 4 missing,102,59 given antibiotics,I,5 (8.5%) Not appropriate,54,C,7 (14.8%) Not appropriate,47,R,D,D,8 (15.2%) Not appropriate,I: Indication C: Choices R,D,D: Route, Duration, Dose,Overal
10、l 34% Not appropriate,Results,The standard achieved in our unit,Situation in other areas antibiotics were prescribed for 55.4% of the patientsTherapeutic use was considered inadequate in 27% Fonseca LG, Conterno Lde O. Audit of Antibiotic Use in a Brazilian University Hospital. Braz J Infect Dis 200
11、4 Aug; 8(4): 272-80. Epub 2004 Nov 19 73% of prescriptions conformed to guidelines, but adequacy varied from 93% for vancomycin to only 38% for ciprofloxacin Marie T, Frederique S et al. Appropriate use of restricted antimicrobial agents in hospitals: the importance of empirical therapy and assisted
12、 re-evaluation. J Antimicro Chemo (2000) 46: 501-508,66% (95% CI 54% - 78%),Situation in other areas 105 prescriptions were analysed 22 cases excessive, 8 cases unjustified and 5 cases inappropriate Zahar JR, Ghaffari P. Audit on antibiotic prescriptions in a department of infectious diseases. Press
13、e Med 2003 Aug 9:32(26):1208-12 Two third appropriate 67% appropriate at the primary level as opposed to 60% at the tertiary level Thomas Molly, Moses B Monitoring of Antibiotic Use in a Primary and a Tertiary Care Hospital. J Clin Epid 1996 Feb 2:49: 251-254,66% (95% CI 54% - 78%),Antibiotic use in
14、 different infections,Augmentin 69% of admissions which antibiotics were prescribed,Implementation,Holding seminar on antibiotic use Case studies on antibiotic use in departmental meeting Distribution & Reinforcement of the use of antibiotic guidelines,Discussion,First audit project auditing the use
15、 of antibiotics in all patients admitted to medical wards in TMH. Over 50% patients admitted were prescribed antibiotics Of all patients given antibiotics, only about two-third was given appropriately.,Discussion,Two-thirds of the problem may be improved by reinforcement on the use of antibiotic gui
16、delines. IMPACT guidelines/ Sanford guide/ Therapeutic guidelines antibiotics/ Production of local guidelines etc. The remaining one-third may be improved by continuous medical education, training on making a correct diagnosis and fine tuning of the clinical skills. No shortcut.,Follow up to complete the audit loop,It is planning to repeat the project one year later for assessment if there is any improvement.,Acknowledgements,Dr. Yeung Yiu Ming, Consultant Dr. Szeto Ming Leung, Consultant Dr. Que Tak Lun, Consultant,Thank you very much,
