CEPHALOSPORIN UTILIZATION REVIEW AND EVALUATION

The clinical misuse of drugs may result in preventable patient morbidi ty and mortality, costly remedial care, additional costs for diagnosis and management of iatrogenic disease and unnecessary wastage of healt hcare resources. In recognition of this problem, drug utilisation eval uation (DUE) has been recommended as a method for identifying inapprop riate or unnecessary drug use and for promoting rational therapy. Grow ing concern over the widespread misuse of antibiotics, together with t he emergence of antimicrobial resistance and escalating expenditures, has resulted in antibiotics being the drugs most frequently chosen for DUE projects. Cephalosporin DUE is well documented as being successfu l for modifying cephalosporin use and for containing drug expenditure. Studies range from isolated projects to ongoing programmes that compr ehensively evaluate cephalosporin use and the impact of corrective str ategies. Sensible use of antibiotics requires a clear understanding of the infectious process, the clinical pharmacology of anti-infective a gents and an appreciation of clinical and microbiological monitoring a nd assessment. Audit criteria that incorporate the above principles, a nd which are described in the studies reviewed in this article, will b e useful for other investigators. Through its DUE programme, the Royal Adelaide Hospital has investigated the use of cephalosporins, includi ng ceftriaxone, ceftazidime and cefoxitin. These reviews have resulted in improvements in cephalosporin use and significant cost savings. Al terations to cephalosporin use that were recommended following these r eviews have not resulted in adverse changes to post-operative infectio n rates, clinical outcomes or adverse drug reactions. This experience, combined with that of other investigators, serves as a useful model f or the promotion of rational and economical therapy with cephalosporin s and other drug groups.