MONITORING OF ANTIBIOTIC USE IN A PRIMARY AND A TERTIARY CARE HOSPITAL

Prophylactic and curative use of antibiotics was studied prospectively in 87 consecutive medical and surgical cases of a tertiary care hospi tal and in 98 cases of a primary care hospital. Based on Kunins' crite ria, antibiotic prophylaxis was found to be more inappropriate in the primary care hospital (49%) than in the tertiary care hospital (34%). Antibiotic therapy, however, was more appropriate at the primary level ; 67% as opposed to 60% at the tertiary level. This resulted in a simi lar overall level of inappropriate antibiotic use in the two hospitals . Surgical prophylaxis was started postoperatively in 68% of the prima ry care hospital cases. Though prophylaxis was always perioperative in the tertiary care hospital, the postoperative duration was more than 7 days in one third of cases. The nosocomial infection rate in those g iven prolonged prophylaxis was higher than those who received antibiot ics for less than 72 hours. Antibiotics were started empirically in 78 % of tertiary hospital care cases and 100% of cases in the primary hos pital. Though culture sensitivity was done in 80% of the tertiary care cases, more than half the specimens were sent after multiple doses of antibiotics were started. The choice of antibiotic did not always cor relate with the sensitivity report. Though cost effective drugs were c hosen in 50% of cases, in more than 20% of cases expensive drugs were started. The study highlights the need for an antibiotic audit and sug gests the necessity of having an ongoing peer audit.