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A Study of Inappropriate Dosing of Antibacterial Agents in Consideration with Estimated G.F.R Values
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Background: Medication errors due to inappropriate doses are common in hospitalized patients especially in those patients where a dose adjustment is needed because of altered pharmacokinetics and pharmacodynamics.
Aims & Objective: The study was conducted to estimate the medication errors because of inappropriate dosing of antimicrobial agents in renal impairment patients.
Design & Setting: The present study was conducted for a period of three months in the medical wards of tertiary care centre in India. The age, sex, clinical diagnosis, duration of hospitalization, parenteral antibacterial agent information (name, dose, route of administration and frequency) and serum creatinine values of those patients admitted during the study period were recorded.
Material and Method: The prescriptions of only those patients who had renal impairment were checked for any errors because of inappropriate dosing of antimicrobial agents. The definition of "Renal impairment" for the purpose of drug dose adjustment and cautions was obtained from the British National Formulary. The MDRD formula was used in our study to obtain the values of estimated glomerular filtration rate (GFR), which is as follows- GFR = 186.3 x (S. Creatinine) -1.154 x (age in years) - 0.203 x 1.212 x 0.742 (if female).
Results: Three hundred and ninety patients were prescribed anti-microbial agents during the three month study period in the medical wards. 182 patients were prescribed a single antibiotic, while 122 patients were prescribed two anti-microbial agents. 70 patients were prescribed 3 anti-microbial agents, while 4 anti-microbial agents were prescribed to 16 patients. The median duration of hospitalization was 5 days. The most common type of infection for which an antibiotic was prescribed was respiratory infections 44.87 % (175), followed by urinary tract infections (UTI) (56, 14.3 %) and abdominal infections (34, 8.72 %). Out of 390 patients, 78 patients had renal impairment (34 had mild renal impairment, 28 had moderate, and 16 patients had severe renal impairment). These patients were prescribed 2137 unit doses of antimicrobial agents (1119 in mild; 753 in moderate; and 265 in severe renal impairment). Inappropriate dosing errors were found in 183 unit doses of AMA (8.56%). Out of this, 78 (42.62%) errors occurred in mild, 91 (49.73%) in moderate and 14 (7.65%) in severe renal impairment patients. In all 183 dosing errors appropriate doses were suggested to the doctor in charge. About 83.6 % (153) of the recommendations were accepted and 16.39% (30) recommendations were not accepted by the physicians.
Keywords
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