Abstract
BackgroundCefepime is a fourth generation cephalosporin antimicrobial. Its extended antimicrobial activity and infrequent tendency to engender resistance make it popular for the treatment of infections. However, proper use of cefepime has not been studied adequately. In this study, we used a retrospective cohort and a prospective cohort to evaluate the usage pattern, adverse effects and cost-effectiveness of cefepime by conducting a drug use evaluation (DUE) program in the First Affiliated Hospital of Bengbu Medical College, Anhui, China.MethodsThe DUE criteria for cefepime were established by applying literature review and expert consultation, an effective method to promote interventions that will improve patient outcomes and the cost-effectiveness of drug therapy. According to the criteria, we performed a cross-sectional retrospective (cycle A) study on 96 hospitalized patients who received cefepime treatment and a prospective (cycle B) study on 111 hospitalized patients with cefepime treatment intervention. After identifying problems with usage and completing a cefepime use evaluation for cycle A, 2 months of educational intervention among professionals were given and a more effective and rational system of cefepime use was set up. During the 2 months, the lectures were arranged and attendance of prescribers was required.ResultsThe data from cycle A showed that the biggest problem was irrational prescription of cefepime; bacterial culture and drug sensitivity tests for cefepime were also not carried out. Following 2 months of educational intervention among professionals, the results for cycle B showed that the correct indication rate was 94.59%, compared with 84.38% in cycle A. Use of bacterial culture and sensitivity tests also improved, by 88.29% in cycle B compared with 65.22% in cycle A. Compared with cycle A, the significantly improved items (P < 0.05) in cycle B were blood examination, liver function monitoring, renal function monitoring, dose and duration, dosing frequency and correct medication combinations.ConclusionsCefepime can be used appropriately for the right indications and in a cost-effective way for the majority of patients through educational intervention, including the special precautions that must be followed for appropriate dosing frequency and duration. DUE programs will become one model of hospital pharmacy care and part of the plan for continuous improvements to the quality of health care in China.
Highlights
Cefepime is a fourth generation cephalosporin antimicrobial
According to the drug use evaluation (DUE) criteria for cefepime published by the American Society of Hospital Pharmacists (ASHP), a cefepime regimen should be restricted to the following indications [7]: 1. Treatment of severe infection caused by suspected gram-negative bacteria or mixed aerobic bacteria in hospitalized patients, but not used for infection caused by suspected anaerobic bacteria, enterococci or pivmecillinam-resistant staphylococcal infection; and 2
With regards to drug monitoring and dosage, aspects that were improved in cycle B compared with cycle A included life index record, drug skin test, solvent selection, route of administration, and compatibility
Summary
Cefepime is a fourth generation cephalosporin antimicrobial. Its extended antimicrobial activity and infrequent tendency to engender resistance make it popular for the treatment of infections. Because of its extended antimicrobial activity and infrequent tendency to engender resistance, cefepime is popular for the treatment of infections and is widely used to treat severe nosocomial pneumonia, as well as for empirical treatment of febrile neutropenia, uncomplicated and complicated urinary tract infections, uncomplicated skin and skin structure infections, and complicated intra-abdominal infections [2,3]. It should be used judiciously because unnecessary, improper, and prolonged use may lead to the emergence of cefepime-insensitive bacteria and risk decline in its efficacy [4]. Treatment of the following confirmed infections: urinary tract infections, respiratory tract infections, infections of the skin and subcutaneous tissue; infective endocarditis; osteomyelitis; pathogen infection and bacteremia caused by susceptible organisms sensitive to cefepime, but resistant to other more toxic but less expensive drugs
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