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Pharm World Sci. 2008 Dec;30(6):787-93. doi: 10.1007/s11096-008-9220-9. Epub 2008 May 21.

Influencing the use of antibiotics in a Chinese pediatric intensive care unit.

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  • 1Beijing Children's Hospital, Capital Medical University, 56 South Lishi Road, Beijing 100045, People's Republic of China.

Abstract

OBJECTIVES:

To demonstrate the effectiveness of an intervention in antibiotics prescribing, and evaluate the use of antibiotics in the pediatric intensive care unit (PICU) at the Beijing Children's Hospital.

METHODS:

Our interventions included (1) educating the pediatricians on antibiotics prescribing, (2) applying an antimicrobial spectrum chart, and (3) controlling the prescription of specific antibiotics with the use of a guideline. Nine hundred clinical records, including clinical information and antibiotic usage data, were selected retrospectatively from the PICU admissions during the pre- and post-intervention periods.

RESULTS:

In this 5-year survey, the mean rate of antibiotic prescribing was greater than 95% in the PICU. More than 76% of the prescriptions were started empirically. The most frequently used antibiotics were third-generation cephalosporins. After the intervention, we found a reduction in the rate of antibiotic cost/patient/day (P < 0.05); a decrease in the prescription rate of third-generation cephalosporins and macrolides (P < 0.01); an increase in the prescription rate of beta-lactam/beta-lactamase inhibitors and second-generation cephalosporins (P < 0.01); a reduction in the empiric treatment (P < 0.01); and a significant reduction in the incidence rates of bacterial resistance for imipenem-, cefepime-, and ceftazidime-resistant Pseudomonas aeruginosa (P < 0.05), and cefepime-resistant Escherichia coli and Klebsiella pneumoniae (P < 0.01).

CONCLUSION:

Our interventions led to a significant reduction of broad-spectrum antibiotic prescribing associated with the significant reduction in bacterial resistance in the PICU. The implementation of the antibiotics guideline appeared to be effective.

[PubMed - indexed for MEDLINE]
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