keeping down costs of drug use in hospitals

drug prescribing KEEPING DOWN COSTS OF DRUG USE IN HOSPITALS Antibiotics get the blame . but are they really the arch -villain? W hen discussions ar ise about saving money in hospitals, antibiotics are often pointed to as an area of potent ial economy . The occurrence of infections and the use of ant ibiotics with in a hospital env ironment has been studied in a sing le-dose su rvey in 4 3 hospitals ( > 18,000 beds}in the UK. The survey showed: • ! he infection rate was 19.1 % (9.9 % derived from the community and 9.2 % acquired within the hospital);about twothirds of these patients were on antibiotics. • 22 % of the patients studied were on antibiotic therapy; of these patients. about one-third were on multiple antibiotic therapy and about one-eighth had no infection but were on opera tive pro phylact ic therapy. • The most commonly prescribed antibiotics were the semisynthetic penicillins (ampicillin and its esters. amoxycijlin, cloxac illin an d llucloxacillin) and co-t rimo xazole (tri met hopr im-s ulfamet hoxazcle). 9 % of prescriptions were for metronidazole. Less frequ entl y p rescr ibed were cephalosporins and aminoglycosides, and antibiotics such as eryth romycin, tetracyclines, sulphonamides and fusidicacid were given to less than 7 % of the patients. • Only 17 % of the prescriptions were for parenteral antibiotics (IV therapy was prescribed more often than 1M therapy). Met ronidazole, cephalosporins and aminogtycosides accounted for 68 % of the total cost and parenteral therapy represented 72% of the total. It was interesting that ampicillin accounted for 26 % of usage, but only 8 % of the cost, while metronidazole accounted for 9 % of the usage but 33 % of t he cos t. It was suggested that metron idazole may be overprescribed and possibly parenteral usage (28 % of costs) is unnecessary insome cases where the oral or rectal route could just as well be used. An analysis of the total cost of chemotherapy indicated that it accounted for < I 96 of the total NHS expenditure, so very little in the way of overall savings are likely to be achieved . The incidence of postoperative wound infection was > 40 % wh ich should be largely preventable by preoperative bacteriological investigation and treatment . 'There is no place for complacency in the use of antibiotic therapy. and all doctors should strive for improvement in the prescribing policies.' Leigh, D.A : Journal of Chemoth erap y 1, 119 11 11 0156 _2703/ 81/ 0829_0005 $00.50 / 0 <0 ADIS Press INPHARMA 29 Aug 198 \ 5

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drug prescribing

KEEPING DOWN COSTS OF DRUG USE IN HOSPITALS

Antibiotics get the blame. but are they really the arch-villain?W hen discussions ar ise about saving money in hospitals , antibiotics are often pointed to as an area of potent ia l economy . The

occurrence of infections and the use of ant ibiotics with in a hospital env ironment has been studied in a s ing le-dose su rvey in 4 3hospitals ( >18,000 beds} in the UK. The survey showed:

• ! he infect ion rate was 19.1 % (9.9 % derived from the community and 9.2 % acquired with in th e hospital); about twothirds of these patients were on antibiotics.

• 22 % of the patients studied were on an tibiotic the rapy; of these patients. about one-th ird were on m ultiple antibiot ictherapy and about one-eighth had no infection but were on opera tive pro phylact ic therapy.

• Th e most commo nly prescr ibed antibiotics were the semisynthetic penicillins (ampicillin and its esters. amoxycijlin ,cloxacillin an d llucloxacillin) and co-t rimo xazole (tri methoprim-sulfamet hoxazcle). 9 % of presc riptions were formet ronidazole. Lessfrequentl y prescr ibed were cephalosporins and am inoglycosides, and ant ibiotics such as erythromycin,tetracyclines, sulphonamides and fusidic acid were given to less than 7 % of the patients .

• Only 17 % of the prescription s were for parenteral ant ibiotics (IV therapy was prescribed more often than 1M therapy).Metronidazole, cephalosporins and aminogtycosides accounted for 68 % of the total cost and parenteral therap y represented 72%of the total. It was interesting that ampicillin accounted for 26 % of usage, but only 8% of the cost, wh ile metron idazole

accounted for 9 % of the usage but 33 % of the cos t. It was suggested that met ron idazole may be overprescribed and poss iblyparenteral usage (28 % of costs) is unnecessary in some caseswh ere the oral or rectal route could just as well be used. An analysis

of the total cost of chemotherapy indicated that it accounted for < I 96 of the total NHS expenditure, so very little in the way ofoverall savings are likely to be achieved. The incidence of postoperat ive wound infection was >40 % wh ich should be largelypreventable by preoperative bacteriological investigation and treatm ent .

'There is no place for complacency in the use of antibiotic therapy. and all doctorsshould strive for improvement in the prescribing po licies.'

Leigh, D.A : Journal of Antimi~robial Chemotherapy 1, ~ a9 11911 11

0156_2703/ 81/0829_0005 $00.50 /0 <0 ADIS Press INPHARMA 29 Aug 198 \ 5

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