Utilization Evaluation of Antimicrobial Agents in Neutropenic Cancer Patients in a Teaching hospital: Urgent of Drug Utilization Evaluation Studies

• Main Authors: Hadi Hamishehkar, Elnaz Zoghi, Hadi Chavoushi, Simin Ozar-Mashayekhi, Parina Asgharian, Taher Entezari-Maleki, Haleh Rezaee
• Format: Article
• Language: English
• Published: Research Center for Rational Use of Drugs (RCRUD) 2015-10-01
• Series: Journal of Pharmaceutical Care
• Subjects: Drug Utilization Evaluation; Febrile neutropenia; Antibiotics
• Online Access: https://jpc.tums.ac.ir/index.php/jpc/article/view/36

Background: More than 80% of patients with hematologic  malignancies will develop fever during more than one chemotherapy cycle combined with neutropenia. We aim to evaluate empiric antibiotic strategies in Febrile Neutropenic (FN) cancer patients. Methods: This is a concurrent study performed in the “Shahid Ghazi” teaching hospital, hematology-oncology center of Tabriz, Iran during the period of December 2011 to September2012. During this period, patients with FN were evaluated in view of antibiotics utilization based on Infectious Disease Society of America (IDSA) and National Comprehensive Cancer Network (NCCN) instructions. Results: Seventy patients had a total of 91 episodes of FN in the duration of this study. Among them 63 (90%) patients were the cases of acute leukemia. For 88 (96.7 %) patients, imipenem was used as the initial empirical antibiotic regimen. It was changed to piperacillin/tazobactam in 8 (8.8%) of them without indication. Cultures didn’t obtain before the initiation of empirical therapy in 19 (20.9%) episodes. Empiric vancomycin didn’t discontinue after 3 days even if it was not warranted in 23 episodes. In 16 cases vancomycin was switched to teicoplanin. The fluconazole dosages generally given to patients were all suboptimal. Adjusting the dosages of vancomycin or imipenem was not done correctly in 13 (14.29%) episodes. Conclusion: The results of this study showed that choosing antimicrobial agents and their dosing for prophylaxis and treatment of FN patients and discharge antimicrobial planning of FN patients do not follow the evaluated guidelines. Drug Usage Evaluation studies need to be done regularly in such a center.