Abstract
The recent release, relatively high cost and potential adverse effects of parenterally administered metronidazole prompted a quality-of-use audit at a 1000-bed teaching hospital. Ninety-two courses of treatment in 81 inpatients during a 6-week period were studied. Appropriateness of therapy was assessed on the basis of published indications. Parenterally administered metronidazole was prescribed primarily in anaerobic and anaerobic-aerobic infections. It was used as frequently for prophylaxis as for therapy. Surgical services accounted for 95% of the treatment courses. Inappropriate use was noted in 27 (29%) of the courses: agents other than parenterally administered metronidazole were indicated in 12 (13%), while the dose, dosing interval or duration of treatment was suboptimal in 15 (16%). Substantial savings would be achieved if oral or rectal metronidazole therapy were substituted for intravenous therapy for perioperative prophylaxis in elective colorectal surgery. Written justification for use and automatic stop orders are recommended to improve the cost effectiveness of both prophylactic and therapeutic use of selected antimicrobial agents.
Full text
PDF




Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bell G. A., Fothergill J., Murphy J., Smith J. A. Intravenous prophylactic antimicrobial drugs in elective colorectal operations. Surg Gynecol Obstet. 1983 Mar;156(3):351–354. [PubMed] [Google Scholar]
- Brass C., Richards G. K., Ruedy J., Prentis J., Hinchey E. J. The effect of metronidazole on the incidence of postoperative wound infection in elective colon surgery. Am J Surg. 1978 Jan;135(1):91–96. doi: 10.1016/0002-9610(78)90016-8. [DOI] [PubMed] [Google Scholar]
- Brogden R. N., Heel R. C., Speight T. M., Avery G. S. Metronidazole in anaerobic infections: a review of its activity, pharmacokinetics and therapeutic use. Drugs. 1978 Nov;16(5):387–417. doi: 10.2165/00003495-197816050-00002. [DOI] [PubMed] [Google Scholar]
- Craig W. A., Uman S. J., Shaw W. R., Ramgopal V., Eagan L. L., Leopold E. T. Hospital use of antimicrobial drugs. Survey at 19 hospitals and results of antimicrobial control program. Ann Intern Med. 1978 Nov;89(5 Pt 2 Suppl):793–795. doi: 10.7326/0003-4819-89-5-793. [DOI] [PubMed] [Google Scholar]
- Durbin W. A., Jr, Lapidas B., Goldmann D. A. Improved antibiotic usage following introduction of a novel prescription system. JAMA. 1981 Oct 16;246(16):1796–1800. [PubMed] [Google Scholar]
- Finegold S. M. Metronidazole. Ann Intern Med. 1980 Oct;93(4):585–587. doi: 10.7326/0003-4819-93-4-585. [DOI] [PubMed] [Google Scholar]
- Gahhos F. N., Richards G. K., Hinchey E. J., Prentis J. J. Elective colon surgery: clindamycin versus metronidazole prophylaxis. Can J Surg. 1982 Nov;25(6):613–616. [PubMed] [Google Scholar]
- Höjer H. Antimicrobial prophylaxis in abdominal surgery. J Antimicrob Chemother. 1982 Aug;10 (Suppl A):101–115. doi: 10.1093/jac/10.suppl_a.101. [DOI] [PubMed] [Google Scholar]
- Ioannides L., Somogyi A., Spicer J., Heinzow B., Tong N., Franklin C., McLean A. Rectal administration of metronidazole provides therapeutic plasma levels in postoperative patients. N Engl J Med. 1981 Dec 24;305(26):1569–1570. doi: 10.1056/NEJM198112243052607. [DOI] [PubMed] [Google Scholar]
- Jewesson P. J., Chow A. W. Dealing with the misuse of antibiotics in the hospital. Can Med Assoc J. 1983 May 1;128(9):1061–1062. [PMC free article] [PubMed] [Google Scholar]
- Jewesson P. J., Ho R., Jang Q., Watts G., Chow A. W. Auditing antibiotic use in a teaching hospital: focus on cefoxitin. Can Med Assoc J. 1983 May 1;128(9):1075–1078. [PMC free article] [PubMed] [Google Scholar]
- Johnson M. W., Mitch W. E., Heller A. H., Spector R. The impact of an educational program on gentamicin use in a teaching hospital. Am J Med. 1982 Jul;73(1):9–14. doi: 10.1016/0002-9343(82)90912-3. [DOI] [PubMed] [Google Scholar]
- Kass E. H. Antimicrobial drug usage in general hospitals in Pennsylvania. Ann Intern Med. 1978 Nov;89(5 Pt 2 Suppl):800–801. doi: 10.7326/0003-4819-89-5-800. [DOI] [PubMed] [Google Scholar]
- Klapp D. L., Ramphal R. Antibiotic restriction in hospitals associated with medical schools. Am J Hosp Pharm. 1983 Nov;40(11):1957–1960. [PubMed] [Google Scholar]
- Kowalsky S. F., Echols R. M., Peck F., Jr Preprinted order sheet to enhance antibiotic prescribing and surveillance. Am J Hosp Pharm. 1982 Sep;39(9):1528–1529. [PubMed] [Google Scholar]
- Kunin C. M. Evaluation of antibiotic usage: a comprehensive look at alternative approaches. Rev Infect Dis. 1981 Jul-Aug;3(4):745–753. doi: 10.1093/clinids/3.4.745. [DOI] [PubMed] [Google Scholar]
- Kunin C. M., Tupasi T., Craig W. A. Use of antibiotics. A brief exposition of the problem and some tentative solutions. Ann Intern Med. 1973 Oct;79(4):555–560. doi: 10.7326/0003-4819-79-4-555. [DOI] [PubMed] [Google Scholar]
- Molavi A., LeFrock J. L., Prince R. A. Metronidazole. Med Clin North Am. 1982 Jan;66(1):121–133. doi: 10.1016/s0025-7125(16)31446-8. [DOI] [PubMed] [Google Scholar]
- Morran C., McNaught W., McArdle C. S. Prophylactic co-trimoxazole in biliary surgery. Br Med J. 1978 Aug 12;2(6135):462–464. doi: 10.1136/bmj.2.6135.462. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shapiro M., Townsend T. R., Rosner B., Kass E. H. Use of antimicrobial drugs in general hospitals: patterns of prophylaxis. N Engl J Med. 1979 Aug 16;301(7):351–355. doi: 10.1056/NEJM197908163010703. [DOI] [PubMed] [Google Scholar]
- Strachan C. J., Black J., Powis S. J., Waterworth T. A., Wise R., Wilkinson A. R., Burdon D. W., Severn M., Mitra B., Norcott H. Prophylactic use of cephazolin against wound sepsis after cholecystectomy. Br Med J. 1977 May 14;1(6071):1254–1256. doi: 10.1136/bmj.1.6071.1254. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zeman B. T., Pike M., Samet C. The antibiotic utilization committee. Hospitals. 1974 Apr 16;48(8):73–76. [PubMed] [Google Scholar]
