การประเมินการใช้ยา Ceftazidime ในหอผู้ป่วยอายุรกรรม โรงพยาบาลมหาราชนครราชสีมา (Drug Use Evaluation of Ceftazidime in Medical Ward at Maharat Nakhon Ratchasima Hospital)

Abstract

Maharat Nakhon Ratchasima Hospital is a 1,005 - bed regional medical center Hospital. For this decade the cost of antibiotics has been increasing each year, and accounted for the largest proportion of hospital drug budget. The cost of ceftazidime use was the highest in 1996 financial year. It is perceivable that some of this increased cost could be due in part to an in appropriate use of drug contributing to spreading of bacterial resistance, especially Pseudomonas aeruginosa and important pathogen inside the hospital. Bacterial resistance leads to a failure of drug treatmeny, an increase of side effects and toxicity of drug followed by an increased cost, finally. Hence a drug utitization of ceftazidime was performed during May to August, 1996. One hundred and fourteen hospitalized patients using ceftazidime in medical ward were evaluated concurrently. Guidelines for evaluation of appropriateness of ceftazidime use were derived from some literatures and modified use in the hospital. Ceftazidime was much more prescribed for empiric therapy than document therapy 86 and 28 cases respectively, 104 cases (91.0 %) matched an indication. Therapeutic drug monitoring on the following issues were performed: general characteristics 66 cases (57.9%), renal funtion 82 cases. (71.9%), culture and sensitivity test 80 cases (70.2%). Doses were adjusted in 39 patients (70.9%) with normal renal function and in 2 patients (3.4%) with renal insufficiency. Adverse drug reaction were not assessed because data were not shown. Altogether, 64 patients died. In conclusion, ceffazidime use should be monitored and evaluated for proper indication and dose. Dose adjustment should be considered in patients with abnormal renal function. Pharmicists could play an important role in patient care by participating in a health care team and implementing a drug utilization evaluation process as shown above. The program has been proved to produce an appropriate drug prescription, improve drug effectiveness and reduce drug cost.