Hospital Pharmacy Intern
Head of Department
Promoting good antibiotics use and improving the quality of care in hospitals by optimising treatments is part of the 2005–2008 French National Programme(1) announced by the Ministry of Health to fight nosocomial infections. To achieve this objective, five indicators of performance have been chosen for the programme, antibiotics use being one of them (other indicators include MRSA prevalence infection and the use of hydroalcoholic solutions).
Antibiotics overuse and misuse are now recognised as one of the causes of bacterial resistance.(2) At the Valenciennes Hospital (France), a 1,900-bed complex, where this study was carried out, antibiotics are subjected to either global or nominative (specific antibiotic prescribed for a specific person) prescription and dispensing. The hospital units have a certain stock of antibiotics, and this stock is renewed by a global order to the central pharmacy. Certain other antibiotics (nominative antibiotics; see Table 1) are dispensed to the patient from the pharmacy through a standard prescription that is filled by the prescriber. Nominative antibiotics are given for four days if there is no bacteriological information regarding the infection, and for seven days if an antibiogram is available.
The evolution of antibiotic use
The purpose of this study was to analyse how antibiotics use has evolved in connection with the implementation of these two modalities through:
- A review of antibiotics supply/procurement in units and of changes in oral fluoroquinolones prescription and dispensing modalities.
- Changes in dispensing modalities for nominative prescription antibiotics.
An analysis of the total antibiotic consumption (and consumption of antibiotics on global and nominative prescriptions) was performed and correlated with the establishment activity over the period 1998–2005 (see Figure 1). Data were obtained from the pharmacy, and antibiotic consumption was expressed as defined daily dose (DDD) per 1,000 hospitalisation days. Over this period, we observed a decrease in the trend for antibiotic consumption (–8.5% for all antibiotics and –9.2% for nominative antibiotics).
We observed an increasing trend in antibiotic use, and in 2002 we modified the stock of antibiotics available in the hospital units; this was based on the previous consumptions and the observed overuse of oral fluoroquinolones. Oral fluoroquinolones were removed from the units, and their prescription was changed from global to nominative.
Over the period 2002–2003 a subsequent decrease in total antibiotic consumption (8%), consumption of nominative antibiotics (13% decrease) and the oral fluoroquinolones ofloxacin and ciprofloxacin was observed.
The second intervention modified the administration of nominative antibiotics within the pharmacy. Before 2005, all now-nominative antibiotics were delivered to the hospital units and no distinction was made between patients. In March 2005, the transition from this reglobalised dispensation to dispensing nominative antibiotics to named patients decreased the total number of prescriptions (see Table 2). The average number of prescriptions per working day (six of seven days) decreased from 27.5 to 17.5 (a reduction of 35.6% and a 22% reduction when correlated with activity).
There was an 18% decrease in the use of nominative antibiotics between January 2004 and November 2005, and the total consumption of antibiotics decreased by 4% over the same period.
This study highlights the positive effects of the actions implemented to rationalise antibiotics use and improve quality of care. The nominative dispensing of antibiotics has decreased while global distribution of antibiotics has increased in use. Furthermore, despite the launch of a new molecule, levofloxacin, in 2003, total antibiotics consumption has continued to decline. Thus, pharmacy involvement is important in the optimisation of antibiotics treatments and use, and pharmaceutical interventions could be extended to other domains.
- Ministère de la santé et de la protection sociale (France). Programme national de lutte contre les infections nosocomiales 2005–2008.
- Bronzwaer SL, Cars O, Bücholz U,et al. A European study on therelationship between antimicrobial use and antimicrobial resistance.Emerg Infect Dis 2002;3:278-82.