The use of anti-hyperlipidemia in a private hospital in Yogyakarta during 2013-2019

Background: Lipid modifying agents have an important role in the primary and secondary prevention of cardiovascular diseases such as coronary heart disease and stroke. The use of lipid-modifying agents tends to increase along with the increasing prevalence of these diseases. Objectives: To determine the utilization of lipid modifying agents for hospitalized patients in a private hospital in Yogyakarta during the period of 2013 - 2019 in regard to the agents used and their quantity. Methods: The main data for this study were aggregate data on the use of lipid modifying agents for hospitalized patients during 2013-2019 obtained from the hospital pharmacy department. After identification of the names of lipid modifying agents, the quantities of these drugs were then calculated in units of defined daily dose (DDD) and the final quantity was expressed in DDD/100 bed days (BD). The R2 value from linear regression was used to determine the trend of use of individual agents over the period. Results: There were two pharmacological subgroups of lipid modifying agents used during the period of 2013 – 2019 with an average of total quantity of 14.81 DDD/100 BD. Utilization of statins was approximately 90% of the total use, and utilization of fibrates tended to decrease over the period. Individually, simvastatin use decreased significantly over the period (R2 = 0.885), but atorvastatin use continued to increase (R2 = 0.908) with 10-fold increase from 2013 to 2019. Conclusion: The lipid modifying agents used during the period 2013 - 2019 were predominantly statins, and the utilization of atorvastatin increased significantly during this period. Keywords: lipid modifying agents, ATC/DDD, fibrates, statins

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Impact of a pharmacist-driven antimicrobial stewardship program in a private hospital in Costa Rica

Revista Panamericana de Salud Pública ◽

10.26633/rpsp.2020.57 ◽

2020 ◽

Vol 44 ◽

pp. 1

Author(s):

José Pablo Díaz-Madriz ◽

Eugenia Cordero-García ◽

José Miguel Chaverri-Fernández ◽

Esteban Zavaleta-Monestel ◽

Josué Murillo-Cubero ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Private Hospital ◽

Bacterial Resistance ◽

Defined Daily Dose ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Days Of Therapy ◽

Daily Dose ◽

Resistance Patterns ◽

The Impact

Objective. To measure the impact generated by the implementation of the pharmacy-driven antimicrobial stewardship program of the Clínica Bíblica Hospital. Methods. This is a retrospective observational study that evaluates the consumption of antibiotics for the periods before and during implementation of the Clínica Bíblica Hospital antimicrobial stewardship program, calculated by means of defined daily dose per 1 000 patient-days and days of therapy per 1 000 patient-days. In addition, bacterial resistance patterns for the periods 2014–2015 and 2016–2017 were compared. Results. Consumption of most-used antibiotics was calculated, looking for trends that might be associated with the activities implemented by the Clínica Bíblica Hospital antimicrobial stewardship program. Comparing some of the antibiotics with the highest consumption in periods I and II, use of levofloxacin and ceftriaxone showed a decrease of 54.0% (p < 0.001) and 14.6% (p = 0.003), respectively, whereas there was an increase in the use of cefazolin of 4 539.3% (p < 0.001). Regarding percentage of bacterial resistance, in most bacterial isolates no statistically significant changes were observed between the two periods. Conclusions. A reduction in the overall consumption of antibiotics has been achieved over time, most likely attributable to the antimicrobial stewardship program. However, this trend was not observed for all the antibiotics studied. The pattern of resistance among the commonly isolated microorganisms did not vary greatly between the periods studied, which suggests that either the antimicrobial stewardship program may have prevented an increase in bacterial resistance since its implementation, or that it is too soon to see impact on bacterial resistance.

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THE DEFINED DAILY DOSE PER 100 BED-DAYS AS A UNIT OF COMPARISON AND A PARAMETER FOR STUDYING ANTIMICROBIAL DRUG USE IN A UNIVERSITY HOSPITAL: A RETROSPECTIVE STUDY OF THE EFFECTS OF GUIDELINES AND AUDIT ON ANTIMICROBIAL DRUG USE

Journal of Clinical Pharmacy and Therapeutics ◽

10.1111/j.1365-2710.1982.tb01030.x ◽

1982 ◽

Vol 7 (4) ◽

pp. 251-260

Author(s):

Y. A. Hekster ◽

T. B. Vree ◽

R. J. A. Goris ◽

J. B. J. Boerema

Keyword(s):

Retrospective Study ◽

Drug Use ◽

Antimicrobial Drug ◽

University Hospital ◽

Defined Daily Dose ◽

Daily Dose ◽

Bed Days

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Evaluation of a Multidisciplinary Antimicrobial Stewardship Program in a Saudi Critical Care Unit: A Quasi-Experimental Study

Frontiers in Pharmacology ◽

10.3389/fphar.2020.570238 ◽

2021 ◽

Vol 11 ◽

Author(s):

Abdul Haseeb ◽

Hani Saleh Faidah ◽

Manal Al-Gethamy ◽

Muhammad Shahid Iqbal ◽

Abrar Mohammed Barnawi ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Antimicrobial Stewardship ◽

Audit And Feedback ◽

Antimicrobial Use ◽

Defined Daily Dose ◽

Daily Dose ◽

Quasi Experimental ◽

Bed Days

Background: Antimicrobial stewardship programs (ASPs) are collaborative efforts to optimize antimicrobial use in healthcare institutions through evidence-based quality improvement strategies. With regard to critically ill patients, appropriate antimicrobial usage is of significance, and any delay in therapy increases their risk of mortality. Therefore, the implementation of structured multidisciplinary ASPs in critical care settings is of the utmost importance to promote the judicious use of antimicrobials.Methods: This quasi-experimental study evaluating a multidisciplinary ASP in a 20-bed critical care setting was conducted from January 1, 2016 to July 31, 2017. Outcomes were compared nine months before and after ASP implementation. The national antimicrobial stewardship toolkit by Ministry of health was reviewed and the hospital antibiotic prescribing policy was accordingly modified. The antimicrobial stewardship algorithm (Start Smart and Then Focus) and an ASP toolkit were distributed to all intensive care unit staff. Prospective audit and feedback, in addition to prescribing forms for common infectious diseases and education, were the primary antimicrobial strategies.Results: We found that the mean total monthly antimicrobial consumption measured as defined daily dose per 100 bed days was reduced by 25% (742.86 vs. 555.33; p = 0.110) compared to 7% in the control condition (tracer medications) (35.35 vs. 38.10; p = 0.735). Interestingly, there was a negative impact on cost in the post-intervention phase. Interestingly, the use of intravenous ceftriaxone measured as defined daily dose per 100 bed days was decreased by 82% (94.32 vs. 16.68; p = 0.008), whereas oral levofloxacin use was increased by 84% (26.75 vs. 172.29; p = 0.008) in the intensive care unit.Conclusion: Overall, involvement of higher administration in multidisciplinary ASP committees, daily audit and feedback by clinical pharmacists and physicians with infectious disease training, continuous educational activities about antimicrobial use and resistance, use of local antimicrobial prescribing guidelines based on up-to-date antibiogram, and support from the intensive care team can optimize antibiotic use in Saudi healthcare institutions.

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CONSUMPTION TREND OF OPIOIDS IN AMBULATORY PATIENTS IN ALBANIA 2014-2019

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2021.v14i11.42988 ◽

2021 ◽

pp. 124-128

Author(s):

LAERTA KAKARIQI ◽

SOKRAT XHAXHO ◽

LEONARD DEDA ◽

GENTIAN VYSHKA

Keyword(s):

Palliative Care ◽

Opioid Analgesics ◽

Fold Increase ◽

Medical Professionals ◽

Defined Daily Dose ◽

Anatomic Therapeutic Chemical ◽

Ambulatory Patients ◽

Daily Dose ◽

Utilization Data ◽

Maximal Rise

Objective: The aim of this paper is to evaluate 6‐year trends in community use of prescribed opioid analgesics in Albania, using the Anatomic Therapeutic Chemical Classification-Defined Daily Dose methodology. Methods: We collected the data from the database of the Health Insurance Institute (HII). Analysis of the data includes the period 2014–2019; also, we analyzed the data of import and domestic production of drugs, which represent the real consumption of drugs in the country. These data were subsequently involved in a comparative analysis of the utilization data according to the HII. Results: We report a 2.5 fold increase in opioid utilization over the study period. The maximal rise in consumption refers to fentanyl, oxycodone, and tramadol. Meanwhile, the maximal values of consumption refer to strong opiate, morphine. We note that around 30% of the consumption of this class flows out of the scheme. Furthermore, around 25% of consumption of morphine and oxycodone flows out of scheme too. Meanwhile, the tramadol consumption runs out of the scheme over 200%. Conclusions: The outcomes indicate that patients in Albania have low access to opioids medications mainly because of low opioids availability. A strong opiophobia among the population and the medical professionals constitutes one of the major impediments for efficient palliative care.

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Studi Literatur tentang Kuantitatif Penggunaan Antibiotik pada Bangsal Bedah dengan DDD

KELUWIH: Jurnal Kesehatan dan Kedokteran ◽

10.24123/kesdok.v2i1.2975 ◽

2020 ◽

Vol 2 (1) ◽

pp. 9

Author(s):

Ervin Colyn ◽

Fauna Herawati ◽

Rika Yulia

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Prophylaxis ◽

Study Design ◽

Defined Daily Dose ◽

Search Term ◽

Surgical Prophylaxis ◽

Cross Sectional ◽

First Choice ◽

Daily Dose ◽

Bed Days

Abstract— Antibiotic resistance is one of the healthcare problems associated with higher medical costs, prolonged hospital stays, and increased mortality rate. Monitoring antibiotic usage purposed to control the incidence of antibiotic resistance. Past research reported that there was an irrational use of surgical prophylaxis in Asia. The objective of this research is to review surgical prophylaxis utilization using DDD method with DDD/100 Bed Days as outcome. The study design used is systematic review. The articles included in this study were cross-sectional study design, in Indonesian or English language, and published between the years 2010-2020. The defined daily dose, antibiotic prophylaxis, surgery were the search term. This study assesses the quality of journals by The Joanna Briggs Institute (JBI) checklist and the journal's reputation. There were eleven articles, five articles had a good quality according to JBI checklist and published at journal indexed Scopus or accredited by National Journal Accreditation (ARJUNA) SINTA 1-3. The most used surgical prophylaxis antibiotic in 6 locations was ceftriaxone. Meanwhile, Cefazolin, the first choice surgical prophylaxis antibiotic recommended by the guideline, only reported being used the most at 2 locations. In Asia, there are irrational surgical prophylaxis antibiotic utilizations. The monitoring of surgical prophylaxis antibiotic use needs to be improved to increase the appropriateness.Keywords: Defined Daily Dose, antibiotic prophylaxis, surgery, Asia Abstrak—Resistensi antibiotik merupakan salah satu masalah kesehatan karena meningkatkan biaya perawatan, memperpanjang lama rawat di rumah sakit, dan meningkatkan angka kematian. Pemantauan penggunaan antibiotik bertujuan untuk mengendalikan kejadian resistensi antibiotik. Penelitian terdahulu melaporkan bahwa masih banyak terjadi pemakaian antibiotik secara irasional di bangsal bedah di Asia. Penelitian ini bertujuan untuk mengkaji pola pemakaian antibiotik di bangsal bedah dalam satuan DDD/100 bed days. Penelitian ini merupakan kajian sistematik. Artikel terpilih dalam penelitian ini adalah artikel penelitian potong lintkang, berbahasa Indonesia atau Inggris, dan dipublikasi antara tahun 2010 sampai 2020. Kata kunci yang dipakai adalah defined daily dose, antibiotic prophylaxis, surgery. Kualitas jurnal dinilai dengan checklist Joanna Briggs Institute (JBI) dan reputasi jurnal. Hasil: Didapatkan sebelas artikel, lima jurnal memiliki kualitas baik menurut checklist JBI dan dipublikasi oleh jurnal terindeks Scopus atau terakreditasi Sinta 1-3. Berdasarkan hasil sintesis, antibiotik golongan sefalosporin merupakan antibiotik yang paling sering dipakai. Seftriakson dilaporkan pada 6 lokasi sebagai antibiotik yang paling sering dipakai sebagai profilaksis pembedahan, sedangkan sefazolin, antibiotik pilihan utama yang direkomendasikan oleh pedoman terapi, hanya dilaporkan paling banyak digunakan di 2 lokasi. Di Asia, penggunaan antibiotik profilaksis di bangsal bedah masih ada yang irasional. Pemantauan penggunaan antibiotik profilaksis di bangsal bedah perlu ditingkatkan.Kata kunci: Defined Daily Dose, antibiotik profilaksis, bangsal bedah, Asia

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Antibiotic usage at a private hospital in Central Java: results of implementing the Indonesian Regulation on the Prospective Antimicrobial System (Regulasi Antimikroba Sistem Prospektif Indonesia [RASPRO])

International Journal of Infection Control ◽

10.3396/ijic.v17.20411 ◽

2021 ◽

Author(s):

Ronald Irwanto Natadidjaja ◽

Tarcisius Henry ◽

Hadianti Adlani ◽

Aziza Ariyani ◽

Rika Bur

Keyword(s):

Private Hospital ◽

Descriptive Study ◽

Antibiotic Consumption ◽

Defined Daily Dose ◽

Intravenous Antibiotic ◽

Central Java ◽

Stewardship Program ◽

Daily Dose ◽

Before And After ◽

Preliminary Study

Methods: A pre–post-descriptive study was conducted in 2019 for 3 months at a private hospital in Central Java, Indonesia, to evaluate the implementation of the Regulation on Indonesian Antimicrobial Stewardship Program (ASP), namely, the Prospective Antimicrobial System/Regulasi Antimikroba Sistem Prospektif Indonesia (RASPRO). Outcomes were measured before and after the implementation of the RASPRO in the ward including: 1) intravenous antibiotic defined daily dose (DDD) per 100 patient-days, 2) antibiotic expenditure, and 3) antibiotic expenditure per inpatient. Result: The total antibiotic consumption was expressed in DDD/100 patient-days. For the levofloxacin category, the number increased intensely from 2.38 to 15.29; carbapenem escalated from 0.51 to 2.31, ceftriaxone from 32.10 to 38.03, and ampicillin sulbactam from 1.14 to 1.18. In contrast, cefuroxime significantly reduced from 17.25 to 1.38, cefotaxime decreased from 10.33 to 6.83, gentamicin decreased from 3.18 to 1.91, and amikacin decreased from 2.27 to 2.13. The overall cephalosporin usage decreased from 19.89 to 15.41. The total antibiotic expenditure had a decline of 20.28%, followed by 14.44% reduction on the percentage of antibiotic expenditure per inpatient. Conclusion: Our study describes the 3-month analysis of antimicrobial usage before and after the implementation of the RASPRO by evaluating several parameters. The antibiotic consumption expressed in DDD/100 patient-days for each antibiotic category has demonstrated that there are different impacts that may be debatable and calls for further evaluation. A decrease in the total antibiotic expenditure has also been reported. However, since our study is a preliminary study, it should be continued by further studies that involve longer study duration to observe further impacts of the program.

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ANTIBIOTIC USE IN SLOVENIAN HOSPITALS

International Journal of Research -GRANTHAALAYAH ◽

10.29121/granthaalayah.v7.i11.2020.364 ◽

2020 ◽

Vol 7 (11) ◽

pp. 249-258

Author(s):

Tatjana Pokrajac ◽

Milan Čižman ◽

Bojana Beovič

Keyword(s):

Antibiotic Use ◽

Antibiotic Consumption ◽

Defined Daily Dose ◽

Total Consumption ◽

Test Analysis ◽

Weighted Linear Regression ◽

Case Mix Index ◽

Regression Test ◽

Daily Dose ◽

Bed Days

Abstract: Motivation/Background: Antibiotics are commonly overused and misused what increase the emergence of resistant organisms, side- effects and costs. To assess the appropriate use of antibiotics many methods are available. The aim of the present study is to find correlation between antibiotic use and case mix index (CMI) in Slovenian hospitals. Method: In retrospective study (in the years between 2004 and 2013) we correlated the total consumption of antibiotics for systemic use and CMI. Weighted linear regression test analysis was performed to determine correlation between defined daily dose (DDD) / 100 admissions and DDD / 100 bed-days and CMI. Results: The total antibiotic consumption in all included hospitals was in mean 317.69 DDD / 100 admissions and 58.88 DDD / 100 bed days, respectively. CMI range were from 1.25 to 3.55. A significant correlation between consumption expressed in DDD / 100 admissions and CMI (p = 0.028) and DDD / 100 bed days and CMI (p =0.008) was found. Conclusions: Thus, detailed analysis of correlations between DDD of antibiotics and CMI may constitutes a proper use of antibiotics.

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Antibiotic Utilization Pattern in the Intensive Care Unit of Tertiary Hospital in West Java, Indonesia

International Journal of Integrated Health Sciences ◽

10.15850/ijihs.v7n2.1633 ◽

2019 ◽

Vol 7 (2) ◽

pp. 81-87

Author(s):

Taradharani Wikantiananda ◽

Adi Imam Tjahjadi ◽

Reza Widianto Sudjud

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Anatomical Therapeutic Chemical ◽

Antibiotic Use ◽

Tertiary Hospital ◽

Defined Daily Dose ◽

Antibiotic Utilization ◽

Daily Dose ◽

Bed Days ◽

International Measurement

Objective: To find out the pattern of antibiotic utilization in intensive care unit (ICU). The high use of antibiotics in intensive care may increase antibiotic resistance. Methods: This was a retrospective study with total sampling method from patients who were treated in ICU in the period of January to June 2016. Selected data is processed using the Anatomical Therapeutic Chemical (ATC) Classification/Defined Daily Dose (DDD) system as an international measurement standard for analyzing and comparing usage applied by the WHO. Results: The results showed that of the 57 medical records collected, the total antibiotic use was 295.72 DDD/100 bed-days. Levofloxacin, meropenem, ceftriaxone, ceftazidime, and metronidazole were the five maximally utilized antibiotics with 143.18, 49.88, 30.62, 19.74, dan 16.99 DDD/100 bed-days respectively. Conclusion: The most frequently used of antibiotics is ceftriaxone, used in 54.39% of patients. Whereas in number, the most widely used antibiotic is levofloxacin with a total of 143.18 DDD/100 bed-days.

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