Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Rational drug use of antibiotics in a Neonatal Intensive Care Unit,Dr N Schellack,Prof AGS Gous,Department of Pharmacy,University of Limpopo(Medunsa Campus),Introduction,Rational Drug use in the NICU is defined as,“the rational use of drugs requires that patients receive medications appropriate to their clinical needs,in doses that meet their own individual requirements,for an adequate period of time,and at the lowest cost to them and their community.”,(Quick,et al,1997:422),According to Quick,et al,(1997:422)RDU includes the following criteria:,Correct drug,Appropriate indication,Appropriate dosage,administration,and duration of treatment;,Appropriate patient,Correct dispensing -this includes correct dispensing,Patients adherence to treatment.,Rational Drug use objectives,Following recurrent outbreaks of neonatal,Candida,in the NICU prompted the management of the hospital to investigate the use of antibiotics in the NICU,to eliminate the likelihood that irrational use of antibiotics might have been one of the causes.,Background,Methods,A total of 1041 patients,With 882 discharges and 159 deaths,Data collection period:8 months(131days),Ward occupancy rate of 107.17%,100 patients data were selected as a sample.,What antibiotics were used and how were they administered “Correct drug”,Of the 100 patients followed,95 patients received intravenous antibiotics,of which 91 received antibiotics included in the units protocol,Four patients received alternative antimicrobial therapy(e.g.tobramycin and ceftazidime)as required by their clinical conditions and sensitivity results.,Results,Results,Antimicrobials included in the investigation of IV use in NICU,Amikacin,Ampicillin,Benzylpenicillin,Cefepime,Cefotaxime,Cefoxitin,Ceftazidime,Ceftriaxone,Cefuroxime,Ciprofloxacin,Cloxacillin,Co-trimoxazole,Erythromycin,Gentamicin,Meropenem,Metronidazole,Piperacillin/,tazobactam,Tobramycin,Vancomycin,Number of antibiotics per patient,The average number of antibiotics used per patient during the study period was 3.3.Figure 2 shows the numbers of patients who received different numbers of antibiotics.,Results,Duration of use,Of the 91 patients who received intravenous antibiotics included on the ward protocol,52 received at least one of their antibiotics for more than 10 days.Table 2 shows the minimum,average and maximum number of days of use of each antibiotic,Results,Methicillin-resistant Staphylococcus aureus(MRSA),Ten of 91 patients who were given antibiotics from the ward protocol received vancomycin.For all ten of these patients laboratory sensitivity cultures had been requested and the vancomycin was instituted following the positive sensitivity results for MRSA.,Results,Proposed process for providing pharmaceutical care:,-,-,Receive a referral letter,from a health care,professional,Score and allocate,the patient,Re-score and re-allocate the patients on a daily basis,Follow the patient,with appropriate,Pharmaceutical care,1,2,3,4,Entry,Exit,Time demand related to pharmaceutical care visits,Score:6 to 20 Low 1 to 2 visits per week21 to 34 Moderate 2 to 3 visits per week =35 High Everyday,Antibiotics were used according to the ward protocol in the majority of cases.Deviations from the protocol were due to the fact that patients clinical condition and sensitivity results necessitated alternative antimicrobial treatment.,Conclusion,Babies and their parents,for participating in the study,Doctors and nurses,in the NICU for their cooperation,Monika Zweygarth,for assistance with the analysis of the data,Medical Research Council,for financial support,Department of Pharmacy,for logistical support,Acknowledgements,