Use of carbapenems in Colombo South Teaching Hospital (CSTH)

Abstract

Objective: To evaluate utilization of imipenem and meropenem at the Colombo South Teaching Hospital (CSTH)

Methods: The study was performed at CSTH in two parts; a retrospective descriptive study (Part I) and a prospective descriptive study (Part II). In Part I, utilization data on carbapenems in 2009 and 2010 were obtained by reviewing records at the in-door pharmacy. In Part II, bed head tickets (BHTs) of the patients treated with carbapenems were assessed from 01/01/2011 to 15/06/2011. Appropriateness of initiating carbapenem treatment was evaluated according to the Sri Lanka Medical Association (SLMA) antibiotic guidelines.

Results: Use of meropenem and imipenem during 2009 and 2010 in CSTH is summarized in Table1.

Item(No. of vials)

Year

Variance (%)

2009

2010

Meropenem 1g

2264

3010

+32.95%

Meropenem 500mg

2258

4418

+95.66%

Imipenem 500mg

1056

648

-38.64%

Table1: Use of meropenem and imipenem during 2009 and 2010 in CSTH

179BHTs were reviewed to evaluate whether carbapenems have been prescribed according to SLMA guidelines. According to the evidence recorded in BHTs in 55.31% of the patients carbapenems have not been prescribed according the guidelines. The most common indications for inappropriate use were urinary tract infections(12.29%), post-surgery 10.61%) and community acquired pneumonia(14.52%).

Conclusions: Carbapenems should be used for serious and life threatening infections suspected or proven to be caused by bacteria resistant to other commonly used antimicrobials but susceptible to carbapenems. Inappropriate use of carbapenems increases the development of bacterial resistance and use may not be cost effective. Therefore we suggest that guidelines on usage of antibiotics need to be established and clinicians should adhere to such guidelines.