Abstract
Drug Utilization Evaluation (DUE) studies are designed to evaluate and improve the rational use of medications. In this study, DUE has focused on drugs used in high risk patients such as critically ill cases. Carbapenems are beta-lactam type antibiotics with broad-spectrum of activity which cover gram-positive, gram-negative and anaerobic bacteria. The heavy use of carbapenems (imipenem or meropenm) could increase the risk of multi-drug resistant (MDR) pathogens. This study was a prospective and cross sectional study performed at intensive care unit (ICU) of Al-Matwakel hospital in Sana'a, Yemen. The study was conducted from September 2018 to March 2019. All of the patients were on imipenem or meropenem as an empiric treatment or based upon microbiology culture results included in the study. Total of 80 patients at ICU were evaluated. The results of the study showed that empiric therapy was in most cases (91.25%; P< 0.001).In addition; about 36.3% of the patients required dosage adjustment according to glomerular filtration rate (GFR) stages. Also according to GFR calculation, 43.8% of the patients were in stage 3. In the present study, the frequency of therapeutic duplication of ceftriaxone with carbapenem was reported in 38 patients. The major drug-drug interactions were observed with tramadol-imipenem, tramadol-meropenem, and amlodipine-simvastatin. The result of the study showed that empiric therapy was unjustified in most cases (91.25%). In addition, about 36.3% of the patients required dosage adjustment according to GFR stages. According to GFR calculation, 43.8% of the patients were in stage 3. In the present study, the frequency of therapeutic duplication and drug-drug interactions were observed.
 Peer Review History: 
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 Received file 
 
 Average Peer review marks at initial stage: 4.5/10
 Average Peer review marks at publication stage: 8.0/10
 Reviewer(s) detail:
 Name: Dr. (Mrs) Amaka Mgbahurike
 Affiliation: University of Port Harcourt, Nigeria
 E-mail: amaka_mgbahurike@yahoo.com
 
 Name: Dr. Mahmoud S. Abdallah
 Affiliation: University of Sadat city, Egypt
 E-mail: dr_samy777@yahoo.com
 Comments of reviewer(s): 
Highlights
INTRODUCTIONOne of the most important elements in patient care process is to evaluate the appropriateness of medication use
The data was analyzed in order to identify dosage adjustment according glomerular filtration rate (GFR) stages, carbapenem selection according to culture results or empirical therapy, major and moderate drug-drug interactions and antibiotic used in combination with carbapenem
80% of the patients were on meropenem and 20% of total patients on imipenem drug
Summary
One of the most important elements in patient care process is to evaluate the appropriateness of medication use. Medications review studies are aimed to evaluate and improve the rational use of drugs. They have mostly focused on drugs with higher cost, higher dispensing, relatively narrow therapeutic margin and broad spectrum antibiotics. They focus on medications prescribed in specialized populations such as elderly, critically ill, post-surgical and cancer patients[1]. Carbapenem (imipenem/cilastatin and meropenem) drugs are beta-lactam type antibiotics with a broad spectrum of activity and coverage of Gram-positive and Gram-negative aerobic and anaerobic bacteria. Imipenem/cilastatin and meropenem use have increased as a result of high resistant rates to other antibiotics[2]. Study, utilization of these antibiotics in critically ill patients was reviewed
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