Abstract
Background: Imipenem, a member of the carbapenem class of
beta-lactam antibiotics, is a
broadly active antimicrobial. Due to
indiscriminate use, drug resistance has spread in many hospitals. The aim of
this study was to evaluate utilization of imipenem in Imam Khomeini educational
hospital in Sari.
Methods: Over
a three-month period from
September to November 2010, all patients who received imipenem during
hospitalization were included. Demographic data, duration of imipenem therapy,
dose, dosage adjustment in renal insufficiency and co-prescribed antimicrobials
were extracted from patients' medical files. Recommendations of UpToDate 20.2
and Sanford 2009 were considered as standards of rational imipenem prescribing.
Data analysis was performed by SPSS 17 software.
Results: A total of 100 patients with a mean age of
51.4±21.4 were enrolled in the study. Dose
and duration of imipenem therapy were appropriate in 64 (64%) and 50 (50%)
patients, respectively. In 83 (83%) cases, empiric antibiotic therapy was
initiated within the first day of admission which included imipenem in 31
patients (37%). All patients received imipenem as empiric therapy. The most
common co-prescribed antimicrobial agent with imipenem was vancomycin (66
cases). Imipenem was administered by consult of an infectious specialist just
in 30% of patients. 14 imipenem prescriptions (14%) required dosage adjustment
according to the patient's renal function, whereas it was performed only for 5
(35%) patients. Culture tests were carried out for 29 (29%) cases.
Conclusion: High rate of empiric prescription of imipenem without
considering culture and antimicrobial susceptibility results, lack of attention
to dosage adjustment in renal insufficiency and initiation of antimicrobial
therapy at the time of admission were the most important aspects of irrational
use of imipenem that observed in this study. Providing a reliable
culture/sensitivity setup and prescribing of imipenem based on a specific
guideline are recommended.