Prospective audit of aminoglycoside usage in a general hospital with assessments of clinical processes and adverse clinical outcomes

Li, S C; Ioannides‐Demos, Lisa L; Spicer, W. John; Berbatis, Con G.; Spelman, Denis; Tong, Nicholas; McLean, Allan J.

doi:10.5694/j.1326-5377.1989.tb115996.x

Cited by 23 publications

(4 citation statements)

References 25 publications

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“…As expected, the most common indications for gentamicin use were intra‐abdominal infections and acute pyelonephritis. More than 30.0% of gentamicin courses were given for prophylactic indications, consistent with previous studies; 16 however, the frequent use of stat low doses for urinary catheter manipulation was unexpected (particularly multiple stat doses over many days). Use of prophylactic antibiotics at the time of urinary catheter manipulation is not generally recommended but may be appropriate for selected groups of patients who require relatively short‐term catheterization and are at high risk for complications from a urinary tract infection 17 .…”

Section: Discussionmentioning

confidence: 99%

Providing guidelines and education is not enough: an audit of gentamicin use at The Royal Melbourne Hospital

Leong

Buising

Richards

et al. 2005

Internal Medicine Journal

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Section: Discussionmentioning

confidence: 99%

Providing guidelines and education is not enough: an audit of gentamicin use at The Royal Melbourne Hospital

Leong

Buising

Richards

et al. 2005

Internal Medicine Journal

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“…Centres will need to review local sensitivity patterns to determine if this regimen is suitable for their population. Our move to once-daily aminoglycoside therapy was prompted by the increasing evidence of sub-therapeutic concentrations achieved with conventional thrice-daily schedules 19 and the relatively low levels of nephrotoxicity observed by Nicolau et al 20 with once-daily gentamicin in treating 800 patients over 61 years of age.…”

Section: Discussionmentioning

confidence: 99%

Successful control of Clostridium difficile infection in an elderly care unit through use of a restrictive antibiotic policy

McNulty

Logan²,

Donald³

et al. 1997

Journal of Antimicrobial Chemotherapy

172

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Toxin-producing Clostridium difficile is the commonest bacterial cause of nosocomial diarrhoea and is a well recognized cause of hospital outbreaks in elderly care units. High C. difficile disease rates have been associated with the use of broad-spectrum antibiotics, especially cephalosporins. An outbreak of C. difficile infection in the elderly care unit at Gloucestershire Royal NHS Trust continued despite increased ward cleaning and strict implementation of infection control measures. A restrictive antibiotic policy that would maintain colonization resistance in the gastrointestinal tract was introduced throughout this unit. Patients admitted with suspected infection were prescribed intravenous (i.v.) benzylpenicillin 1.2-1.8 g every 6 h to cover streptococcal infections and i.v. trimethoprim 200 mg twice daily to cover urinary tract pathogens and Haemophilus influenzae. If the patient had septic shock a single iv dose of gentamicin was given (120-180 mg) to cover more resistant gram-negative bacilli. The following were monitored before and after the policy change. The number of cases of C. difficile toxin-positive diarrhoea; cefuroxime and total antibiotic use on the elderly care wards; patient mortality rates; and length of hospital stay: two hundred and fifty-two and 234 patients respectively with a discharge diagnosis of infection were admitted before and after the antibiotic policy change. Mortality rates and length of hospital stay were unchanged. Cefuroxime prescribing and total antibiotic prescribing costs fell by 5150 pounds sterling and 8622 pounds sterling respectively in the 7 month period after the change. Thirty-seven cases of C. difficile diarrhoea occurred in the period before and 16 in the period after the policy change. The incidence of C. difficile diarrhoea and of cefuroxime use has remained low since then. The use of narrow-spectrum antibiotics for hospital treatment of community-acquired infections in the elderly should be encouraged. Outbreaks of C. difficile diarrhoea should be managed with the combined approach of infection control and strict antibiotic policies.

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“…Such combined improvement in clinical practice of vancomycin delivery and improvement in the system should help more effective use of the drug. A similar model has previously been reported to improve use of aminoglycosides with a significant reduction in clinical toxicity (24, 25).…”

Section: Discussionmentioning

confidence: 94%

A retrospective drug utilization evaluation of vancomycin usage in paediatric patients

et al. 2004

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Prospective audit of aminoglycoside usage in a general hospital with assessments of clinical processes and adverse clinical outcomes

Cited by 23 publications

References 25 publications

Providing guidelines and education is not enough: an audit of gentamicin use at The Royal Melbourne Hospital

Providing guidelines and education is not enough: an audit of gentamicin use at The Royal Melbourne Hospital

Successful control of Clostridium difficile infection in an elderly care unit through use of a restrictive antibiotic policy

A retrospective drug utilization evaluation of vancomycin usage in paediatric patients

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