Retrospective evaluation of the use of three systemic antibiotics in a pediatric hospital

This study was conducted to describe and evaluate antibiotic therapy in pediatric patients who were administered ampicillin, cephalosporins or penicillin by any route. Also, an effort was made to determine if variables such as age, length of stay, service, or diagnosis correlated with any categories of antibiotic therapy. The study hospital was a 175-bed, short term, private, non-profit, pediatric hospital serving a metropolitan population. A patient medical record review system was used to collect data on one hundred sixty-seven patients. Therapy was evaluated by determining whether or not signs or symptoms of infection were present, cultures were taken, and pathogens were grown. Using answers to these questions, cases were first assigned to two broad categories of confirmed or unconfirmed use. Confirmed cases were cases in which a pathogen was isolated. The antibiotic-pathogen match was compared with recommendations of representative package inserts and The Medical Letter Drug of Choice. Agreement scores were computed. Unconfirmed cases were further categorized by assignment to either expectant use, probable cause use, and prophylactic use. Finally, each case was judged to be either rational, irrational or questionable. Rational therapy measured 31.2%, and irrational therapy was 20.3% with 48.5% questionable. Prophylactic use was seen in 15% of the cases. Unjustified prophylactic use correlated significantly with surgery service. Antibiotic waste was correlated with surgery, hematology, and neurology services, but waste did not correlate with any of the three antibiotics. The cost of antibiotic waste was calculated using hospital acquisition costs. Waste from failure to discontinue therapy after a negative culture averaged $18.20 per case to the patient. Waste from unjustified casual prophylaxis averaged $13.60 per case.