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.