The Antibiotic Usage Before and After a Nationwide Antibiotic Restriction Policy at a University Hospital

There is a growing concern on wisely use of antimicrobial agents. Some nationwide restrictions on antibiotic usage have been settled via a regulation released by Turkish government in February 2003. We conducted a study to assess the impact of this nationwide antibiotic restriction policy (NARP) at a university hospital. All hospitalized patients were visited on 18th February 2003 (before the regulation) and on 15th September 2003 (after the regulation). For each patient receiving antibiotic treatment, demographic data, diagnosis, results from microbiological specimens, details of antibiotic administration, indication for treatment or prophylaxis, dosage, dose frequency and administration route were recorded on individual forms. The appropriateness of antimicrobial treatments were assessed by two infectious disease specialists and infectious disease proffessors according to the local and international guidelines. On the first prevalence day and on the second prevalence day 20.8% of patients were receiving antimicrobial treatment. Before and after NARP, 36% and 29% of antimicrobial treatments were judged inappropriate, respectively (p= 0.131). There was not any difference between surgical and medical wards. The rate of antibiotic usage without any clinical indication was significantly decreased after NARP (p= 0.03). After NARP, 42% of the empirical treatments was begun after infectious disease consultation, while it was 14% (p< 0.001) before NARP. Fourty-four percent and 36% of antimicrobial regimens used for surgical prophylaxis was inappropriate before and after NARP, respectively (p= 0.39). The daily cost of inappropriate antibiotic usage was 2661 and 2187 dollars in February and September, respectively (p= 0.77). We conclude that, NARP has a good but unsatisfactory impact on antibiotic usage and cost. Other interventions should be implemented for an optimal outcome