Pharmacist intervention in prescribing of cefuroxime for pediatric patients

Abstract

A targeted drug review of cefuroxime use in pediatric patients is described. Because of a 65% increase in cefuroxime costs over one year, pharmacists assessed the appropriateness of cefuroxime therapy from October 13 to December 20, 1987. This assessment was done within 48 hours after the prescription was written and again after 72 hours of cefuroxime therapy, when bacteriology and susceptibility data were available. When a drug order was inappropriate, a pharmacist intervened with the prescribing physician. For comparison, data collection forms were completed for patients who had received cefuroxime before and after the study period. Before the study period, 42% of the cefuroxime orders were inappropriate with respect to dosage or indication at the time of the initial order; this rate fell to 26% during the study period and increased to 33% after the study period. After 72 hours of therapy, the rates of inappropriate prescribing were 48% (before study period), 32% (during study period), and 40% (after study period). During the study period, pharmacists intervened in only half of the 51 cefuroxime orders initially deemed to be inappropriate, and only 26% of these interventions resulted in an order change. Although pharmacists met with some success in increasing the appropriateness of cefuroxime prescribing, both pharmacists and physicians resumed their previous monitoring and prescribing habits after the study period had ended.