drug prescribing KEEPING AN EYE ON HOSPITAL DRUG USE

Over 25 % o f admissions to a Dublin surgical unit receive antibiotics Much concern has been registered about antibiotic misuse and inappropriate prescribing in hospital practice and in the community. Antibiotic usage was monitored over 10 weeks in 500 consecutive patients admitted 10 a 90-bed surgical unil in Dublin. Ireland . 325 patients had surgery and 175 had no operat ive procedure performed. 25.8 % of all pat ients received antibiotics. Antibiotic prophylaxis was given to 2 % of patiems undergoing 'clean' surgery (e.g. hernia repair), I 2 % of those undergoing 'clean/contaminated' surgery (e.g: stomach and gallbladder operations), and 86.5% undergoing 'contaminated' surgery (e.g. operations on colon, mouth or perforated appendix). In intestinal surgery. metronidazole and gentamicin or ampicillin were most commonly used in prophylaxis; metronidazole and neom yci n was the second choice. In gynaecological procedures. tetracycl ine and metronidazole were u~ually given as proph ylax i~. I n thoracic surgery. tetracycline was first choice and cephradine was second. Prophylaxis for ENT surgery most often involved penici ll in. with erythromycin being the second choice. Prophylaxis for urological procedures depended on urinary culture and sensiti vity. 57 % of patients on prophylactic ant ibiotics received these drugs parenterally and 33 % received then orally o r rectally. Prophylaxis was prov ided as a single dose in 5 patients, 3 doses in I 2 patients and up to 3 days postoperatively in 34 palients. Bacteriological support (positive cultures) for infection was found in 12 of 32 patients given antibiotics for suspected infected lesions. Antibiotics most often used in the treatment of postoperative infections included ampicillin (chest infections, acute cholecystitis and postoperative pyrex ia), tr imethoprim (urinary tract infections) and ampicilli n + metronidazole (acute diverticuliti.<;). Treatment of postoperative i nfection~ la<; ted 2 days in 8 patients. 5 days in 20.7 days in 26. 10 days in 10. 2 weeks in 5. and longer than 2

weeks in 2. McCormiCk. T .T. and Hone. R.: trish Medical Journ.al 74: 2841Ckt 1981)

Oextropropoxyphene-paracet amol overdose relates to prescribing Tablets containi ng dex tropropoxyphene (propoxyphene) 32.5mg and paracetamol (acetam inophen) 325mg have frequently been im plicated in overdose cases. I n overdosage. the paracetamol com ponent causes hepatic toxicity and the Ocxtroprupoxyphene component causes n:spi ratory and cardiovascular depression. At the Hereford Hospitals in England, a I · year analysis of 15.939 general medical inpatients showed trends in the use of dextropropoxyphene-paracetamol. 15 % of these .patients were taking analgesics (most frequently. dextropropoxyphene-paracetamoJ) during the week before hospit.a1 admission . 38 % were p re.<;c ribed oral analgesics in hospital. and II % were prcscribed analgesics to take home . The use of dextropropo~yphene-paracetamol increased between 1975 and 1978 , but fell in 197 9. In 1979 the use of paracelamol and dihydrocodeine increao;ed . Pu rcha<;es of dextropropoxyphene init ially rose in 1977, but decreased in 1978 and I 979 . staying constant for 1980. Over 6 year~. there were 525 admissions for analgesic overdClSe. 53. 7 % ca<;e.s involved aspirin compounds. 32.2 % paracetamol , 14 3 % dextropropoxyphene-paracetamol and 2.9 % dihydrocodeine . In 1980 . 15.8% of overdose cases had taken dextropropoxyphene-paracetamol. The lowes t percentage ofhOSpilal admissions for dextropropoxyphene-par aceta mol overdose occurred in 1977 (8.1 % ). I year after the first reports of the hazards of dextropropoxyphene were published. This suggests that negative publicity probably contributed temporari ly to the decrease in abuse of dex tropropo~yphene-paracetamol . Alexander. A.M. l1 al : 8ritish Jour.,..1 or Pharmaceutical Pract ice J : 4 tSep 1981)

OI56-2703/ 82 / 0130-()(X)5 / 0$OO.50/ 0 .e ADIS Press INf'l-jARMA 30 Jan 1982 5