Agreement on the prescription of antimicrobial drugs

Eduardo Casaroto, Alexandre R. Marra, Thiago Zinsly Sampaio Camargo, Ana Rita Araújo de Souza, Carlos Eduardo Saldanha de Almeida, Elizia Piassi Pedroti, Elivane da Silva Victor, Oscar Fernando Pavão dos Santos, Michael B. Edmond, Alexandre Holthausen Campos

There is universal awareness of the difficulties faced by doctors when prescribing antimicrobials. Over a six-month period patients hospitalized in the ICU and under treatment with antibiotics and/or antifungals were eligible to participate in the study. The data were assessed by two infectious diseases specialists. Once completed, all case forms were sent independently to both evaluators (TZSC and ARM) by e-mail. Based on the data received, the evaluator completed a form automatically generated on the e-mail and returned it to the original mailbox for further analysis. We assessed the level of agreement between infectious disease specialists and the physicians directly responsible for the decision to begin antimicrobial therapy, as well as to assess the appropriateness of the regimen prescribed. Among the antimicrobial regimens prescribed to the 177 patients, 36 % were considered inappropriate by specialist #1 and 38 % were considered inappropriate by specialist #2. We found 78 % agreement by at least one of the infectious disease specialists with the prescribed antimicrobial regimen, and in 49 % of cases both specialists agreed with the prescribed regimen. Both disagreed with the prescribed regimen in 22 % of the cases and they disagreed between themselves in 29 % of the cases. This study highlights the difficulties in prescribing effective empirical antimicrobial therapy - they are of such magnitude that even two specialists in infectious diseases, well acquainted with our hospital's resistance patterns and our patients' profiles have considerable disagreement.