Evaluation of antibiotic dosages in patients with a reduced kidney ...

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Evaluation of antibiotic dosages in patients with a reduced kidney ...

Evaluation of antibiotic dosagesin patients with a reducedkidney functionSBIMC- BVIKMNovember 6 th 2008La HulpeFranky Buyleapotheek UZ Gentfranky.buyle@uzgent.be© 2008 Universitair Ziekenhuis Gent 1


ContentBackground and objectiveDesign studyDiscussionConclusion© 2008 Universitair Ziekenhuis Gent22


Background and objectiveLiterature data shows that hospitalized patients with areduced kidney function are frequently treated withinappropriate antibiotic dosagesOverdosage ----- serious adverse reactionsUnderdosage ---- failure of treatment ---- resistancedevelopmentInitiative by the local Antibiotic Policy Group to evaluatethe local practiceProtocol approval by local ethical committee© 2008 Universitair Ziekenhuis Gent33


Retrospective observational study: designInclusion criteria> 18 yearsadmission on internalmedicine, abdominal surgeryor nephrology (period April2006 – March 2007)estimated glomerular filtrationrate (eGFR) < 60mL/min/1,73m 2Exclusion criteriadialysis patientskidney transplant patientspatients < 18 years© 2008 Universitair Ziekenhuis Gent44


Retrospective observational study: designInclusion criteria> 18 yearsadmission on internalmedicine, abdominal surgeryor nephrology (period April2006 – March 2007)estimated glomerular filtrationrate (eGFR) < 60mL/min/1,73m 2Exclusion criteriadialysis patientskidney transplant patientspatients < 18 yearsFormula for measuringkidney functioneGFR with MDRD-formula(Modification of diet in renaldisease)serum creatinine, age, sexcreatinin clearance withCockroft & Gault formulaserumcreatinine, age, sexand weightDatacollectiontrainee pharmacist undersupervison of a hospitalpharmacist and aninfectiologist© 2008 Universitair Ziekenhuis Gent55


Retrospective observational study: designEvaluation of antibiotic dosageevaluation panel: infectiologist, intensive care physician,pharmacistadministered dosages in relation to the creatinineclearancedose adaptations were based on the recommendations of “TheBelgian edition of the Sanford Guide for AntimicrobialTherapy”antibiotic dosages for which therapeutic monitoring isnecessary were evaluated based on plasma concentrations.© 2008 Universitair Ziekenhuis Gent66


ResultsNumber of treatments 99Sex male/female 46/53Number of treatmentsNephrologyGeneral medicineAbdominal surgery272151Mean age (SD) 64,5 (15,3)Number dosages administered 1.364© 2008 Universitair Ziekenhuis Gent77


ResultsNumber administereddosagesNumber correctdosages (%)Number incorrectdosages (%)1.364 1.068 (78,3) 296 (21,7)© 2008 Universitair Ziekenhuis Gent88


ResultsNumber administereddosagesNumber correctdosages (%)Number incorrectdosages (%)1.364 1.068 (78,3) 296 (21,7)Number dosageswithout data (%)Number dosagesoverdosed (%)Number dosagesunderdosed (%)39 (13,2)183 (61,8) 74 (25)© 2008 Universitair Ziekenhuis Gent99


Discussion:Results of similar studiesNumber of inappropriateantibiotic dosages in renalfailure patientsReference86% Cunha B et al. International Journal AntimicrobialAgents 1998;11:167-17733% Falconnier A et al. J Gen Intern Med 2001;16:369-37536% Evans R et al. The Annals of Pharmacotherapy1999;33: 1026-103177% Veen G et al. Pharmaceutisch Weekblad2001;29:1048-5425% Arlicot N et al. Renal Failure 2007;29:1055-1058© 2008 Universitair Ziekenhuis Gent1010


Discussion:Instruments for optimising prescribing forpatients with a reduced kidney function?Promoting guidelines (passive, active)Clinical Decision Support System (CDSS) linked to aComputerized Physician Order Entry (CPOE) (Evans R et al. TheAnnals of Pharmacotherapy 1999;33: 1026-1031)Online alertAlert by email or SMSAntibiotic Policy GroupsClinical pharmacists (Olson L Can J Hosp Pharm 2005;58:20-5)© 2008 Universitair Ziekenhuis Gent1111


Discussion:Instruments for optimising prescribing in renalfailure in the Ghent University hospitals?ImprovementsAlert is presented when physicians or clinical pharmacists areconsulting the electronic laboratory resultsThe pop-up ”Your patient has a possibly reduced kidney function. Take carewhen prescribing medication.” appears when an algorithm found an eGFRbelow 60 ml/min/1,73m2 for patients between 18 and 70 years.Letter to al physiciansTask for clinical pharmacist© 2008 Universitair Ziekenhuis Gent1212


ConclusionOne fifth of the patients received an inappropriateantibiotic dosage according the kidney function.An electronic alert was installed to improve theawareness.© 2008 Universitair Ziekenhuis Gent1313


Acknowledgementspharm. T. Verdonck, Faculty of Pharmacyprof. dr. D. Vogelaers, Infectious Diseasesprof. dr. J. Decruyenaere, Intensive care medicinedr. L. Vandekerckhove, Infectious Diseasesdr. T. Fiers, Clinical chemistryprof. dr. A. Dhondt, Nephrologyprof. dr. B. De Hemptinne, Abdominal surgeryprof. pharm. H. Robays, Pharmacy© 2008 Universitair Ziekenhuis Gent1414

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