drug prescribing

ANTIBIOTIC PRESCRIBING: BETTER FOR THERAPY THAN FOR PROPHYLAXIS

But use varied among different medical specialties in a US community hospital Antibiotic use in a community hospital in Arizona was studied for variations between specialties and for appropriate use (using the Veterans Administration's Guidelines/or Peer Review). During August 1977, 310 (29.4 % ) of the 1054 patients discharged had received 479 courses of antibiotics. 287 (60 %) of these courses were judged appropriate. Two-thirds ofthe courses were therapeutic, 72 % being used appropriately. Only 36% of the antibiotics prescribed for prophylaxis were used appropriately . Antibiotic use was considered appropriate in 41 % of the 310 hospitalised patients given antibiotics. Cephalosporins accounted for more than half of all prophylactic courses, and about a third of therapeutic courses. Aminoglycosides, penicillinase-resistant penicillins, and penicillins were more commonly used for therapy than for prophylaxis. Appropriate total antibiotic use did not differ significantly among general surgeons (73 %), internists (72 %), orthopaedists(71 %) and family practitioners (67 %), but levels of appropriate prescribing were significantly lower among urologists (54 %), otolaryngologists (44 % ) and obstetricians (36 %). The most prevalent reasons for inappropriateness were improper dosage or dosage interval, but for cephalosporins the most common reason for misuse was'excessive duration. Jogerst, GJ. and Dippe, S.E.: Journal of the American Medical Association 245: 842<27 Feb 1981l

Enough reports of inappropriate prescription! We now need reports of improvement There have been numerous studies of the appropriateness of antibiotic prescribing. This one adds nothing new or startling, but it is reassuring to know that 72% of patients given therapeutic antibiotics are treated appropriately (especially in view of the disagreement even among experts in medicine). Prophylactic use of antibiotics, however, was 'disappointingly poor' , indicating a need for continuing physician education. A surprising finding, which should be followed up, was the substantial dilTerence in prescribing between different groups of medical specialists. The problems of prescribing have now been clearly identified (by this and other studies). We now need reports of actions that have succeeded in correcting poor prescribing habits. Barclay, W.R.: Journal of the American Medical Association 245: 849 (27 Feb 198 Il

0156-2703/ 81 / 0314-0005 $00.50/ 0 ~ ADIS Press INPHARMA 14 Mar 1981 5