A retrospective evaluation on the use of Cephalosporins in open-heart surgery

• Main Author: Lithco, Elizabeth M.
• Format: Others
• Published: Scholarly Commons 1979
• Subjects: Anti-infective agents; Cephalosporins; Heart Surgery; Medicine and Health Sciences
• Online Access: https://scholarlycommons.pacific.edu/uop_etds/2008; https://scholarlycommons.pacific.edu/cgi/viewcontent.cgi?article=3007&context=uop_etds

On December 7, 1972, a hearing was held in Washington, D.C. on the use and abuse of antimicrobials. Senator Gaylor Nelson of the Sub-committee on the Monopoly of the Select Committee on Small Business stated, "Antibiotics are among the most frequently prescribed drugs in this country exceeded only by the psychoactive drugs." Dr. Charles C. Edwards, former Commissioner of the Food and Drug Administration, recognized that a problem existed and recommended the establishment of a National Task Force on the clinical use of antimicrobials (Kunin, et al., 1973). The following examples of illustrate problems the medical profession faces with antimicrobials. Of the 33 million patients discharged from general hospitals in 1972, 27% received one or more antibiotics during their hospital stay. The totals almost 9 million patients receiving antibiotics during the course of the year (McGowan, 1976). Dr. John Porterfield of JCAH recognized the Pharmacy-Therapeutics and Infection Control Committees as the formal organizational elements with the ultimate responsibility for formulating drug usage studies and overall administration of a quality assurance program. It was the opinion of Zeman et al., (1974), that in a large hospital (more than 500 beds) a separate Antibiotic Utilization Committee may more efficiently handle the volume of data and work. To implement this monitoring system, Brodie and Smith, (1976), recommended five drug utilization review principles: (1) authority, (2) operational and demographic characteristics of the delivery setting and service population, (3) knowledge of the existing pattern of utilization, (4) comparison of the later with local standards, and (5) evaluation of the impact of review on utilization patterns. Pierpaoli, et al., (1976), suggested that, conceptually a monitoring program could include utilization of retrospective and prospective chart review processes, complimented by a formal education program, and in-house controls on the use of certain antibiotics. A monitoring system could consist of evaluating antibiotics in three possible ways: (1) evaluate the usage of an antibiotic, or a family of antibiotics, in all medical-surgical cases, (2) evaluate one type of medical or surgical problem and review prophylactic and therapeutic use of all antibiotics, or (3) evaluate the usage of one antibiotic in one type of medical or surgical problem. The method of studying one antibiotic in one type of clinical condition might have some advantages since the number of variables is much smaller than either of the other two systems. I decided to use this approach and concentrate an open-heart surgery in which the cephalosporins have been used prophylactically.