Rational drug use of antibiotics in a Neonatal Intensive Care Unit

1
Rational drug use of antibiotics in a Neonatal
Intensive Care Unit

• Dr N Schellack, Prof AGS Gous
• Department of Pharmacy
• University of Limpopo (Medunsa Campus)

2
Introduction

• Rational Drug use in the NICU is defined as

the rational use of drugs requires that patients
receive medications appropriate to their clinical
needs, in doses that meet their own individual
requirements, for an adequate period of time, and
at the lowest cost to them and their community.
(Quick et al 1997422)
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Rational Drug use objectives

• According to Quick et al (1997422) RDU includes
  the following criteria
• Correct drug
• Appropriate indication
• Appropriate dosage, administration, and duration
  of treatment
• Appropriate patient
• Correct dispensing - this includes correct
  dispensing
• Patients adherence to treatment.

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Background

• Following recurrent outbreaks of neonatal Candida
  in the NICU prompted the management of the
  hospital to investigate the use of antibiotics in
  the NICU, to eliminate the likelihood that
  irrational use of antibiotics might have been one
  of the causes.

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Antibiotic protocol

• First line
• Penicillin 100 000 IU/kg/dose and
• Amikacin 25 mg/kg/dose (LD) and maintenance dose
  of 20 mg/kg/dose
• Second line
• Piperacillin and Tazobactam (Tazocin) 50
  mg/kg/dose
• Third line
• Meropenem 20 mg/kg/dose administered 12 hourly
• Fourth line
• Ciprofloxacin 10 20 mg/kg/dose administer in 2
  doses 12 hourly

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Methods
A total of 1041 patients
Data collection period 8 months (131days)
With 882 discharges and 159 deaths

100 patients data were selected as a sample.
Ward occupancy rate of 107.17
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Results

• What antibiotics were used and how were they
  administered Correct drug
• Of the 100 patients followed, 95 patients
  received intravenous antibiotics, of which 91
  received antibiotics included in the unit's
  protocol
• Four patients received alternative antimicrobial
  therapy (e.g. tobramycin and ceftazidime) as
  required by their clinical conditions and
  sensitivity results.

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Results
Antimicrobials included in the investigation of
IV use in NICU
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Results
Frequency of antibiotics use ..
Figure 1 illustrates the eight antibiotics most
frequently used in the 95 patients monitored in
this study. Note that most patients received more
than one antimicrobial.
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Results
Number of antibiotics per patient The average
number of antibiotics used per patient during the
study period was 3.3. Figure 2 shows the numbers
of patients who received different numbers of
antibiotics.
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Results
Duration of use
Of the 91 patients who received intravenous
antibiotics included on the ward protocol, 52
received at least one of their antibiotics for
more than 10 days. Table 2 shows the minimum,
average and maximum number of days of use of each
antibiotic
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Duration of antibiotic use
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Methicillin-resistant Staphylococcus aureus
(MRSA)

• Ten of 91 patients who were given antibiotics
  from the ward protocol received vancomycin. For
  all ten of these patients laboratory sensitivity
  cultures had been requested and the vancomycin
  was instituted following the positive sensitivity
  results for MRSA.

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Results
Implementation and improvements to practice

• Pharmaceutical care risk assessment referral
  sheet
• Pharmaceutical care risk assessment score sheet
• New pharmaceutical care forms for NICU
• Amphotericin B rational prescribing tool

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Results
 

• Proposed process for providing pharmaceutical
  care

Receive a referral letter from a health
care professional
Entry
1
Score and allocate the patient


Re-score and re-allocate the patients on a daily
basis
2
4

Follow the patient with appropriate Pharmaceutical
care

3
-
-

 
Exit
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Conclusion

• Antibiotics were used according to the ward
  protocol in the majority of cases. Deviations
  from the protocol were due to the fact that
  patients clinical condition and sensitivity
  results necessitated alternative antimicrobial
  treatment.

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Conclusion

• As one of the doctors stated

All parties benefit, the patient, doctors,
nurses and pharmacists from the discussion we
have during the ward rounds.
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Acknowledgements

• Babies and their parents for participating in the
  study
• Doctors and nurses in the NICU for their
  cooperation
• Monika Zweygarth for assistance with the analysis
  of the data
• Medical Research Council for financial support
• Department of Pharmacy for logistical support