DRUG-USE EVALUATION OF ANTIBIOTICS IN A PEDIATRIC TEACHING HOSPITAL

OBJECTIVE: To determine the incidence and type of antibiotic use varia nces at our institution. DESIGN: Inpatient bacterial culture and susce ptibility results were reviewed for 1 week per month. Medication admin istration records were evaluated to determine whether antibiotic selec tion was appropriate, given the susceptibility of the organism. Proces s indicators included use of the least costly antibiotic, as well as a ppropriate dose, interval, and route of administration. The complete m edical record was reviewed for all patients if management did not appe ar to meet criteria. SETTING: A 225-bed, tertiary-care children's teac hing hospital. RESULTS: Thirty-five (8.2%)) of 428 patients reviewed o ver 12 months had a total of 49 variances: failure to treat (3), treat ment of contaminant/colonizer (2), use of more costly agent (10), fail ure to revise therapy (8), inappropriate route (2), inappropriate empi ric antibiotic (4), incorrect dose (3), unnecessary multiple antibioti cs (6), inappropriate drug (8), and prolonged prophylaxis (3). CONCLUS IONS: Thirty-five patients with 10 types of variances were identified during the study. Follow-up monitoring will assess the impact of educa tional efforts on the incidence of variances. Specific problem antibio tics have been identified for further audits (Infect Control Hosp Epid emiol 1994;15:710-712).