The Rational and Irrational Use of Systemic Antimicrobial Drugs

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Abstract
The use of systemic antimicrobial agents in 1,035 patients consecutively admitted to a 500-bed non-governmental community hospital was evaluated. The indications for antimicrobial therapy for each patient were classified as infection, prophylaxis or symptomatic. Each case of antimicrobial therapy was judged as rational, irrational or questionable. These evaluations were made first by a pharmacy resident, then by a Ph.D. pharmacist, and finally, by a physician. Out of 340 patients receiving systemic antimicrobials, 36% were treated for infection, 54% received prophylactic treatment and 10% symptomatic treatment. Nearly 13% of the therapies were judged rational, 66% irrational and 22% questionable. The Ph.D. pharmacist and the pharmacy resident agreed with 92% and 76% of the physician rationality evaluations, respectively. Of the 223 therapies judged irrational, half were so judged because, although therapy was warranted, the specific therapy used was inappropriate. In the other irrational therapies, no antimicrobial therapy was necessary. There was no pattern of greater therapeutic rationality for those patients who had microbial cultures or sensitivities performed. Adverse drug reactions were experienced by 14% of, the patients who received antimicrobial drugs. The objections to irrational antimicrobial therapy, including cost considerations, are discussed. The need to provide prescribers with the necessary information to make better judgments is mentioned.

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