The use of antibiotics in the medical wards of a teaching hospital in Hong Kong.

Abstract

Chong, Kam Lin.Thesis submitted in: December 2002.Thesis (M.Phil.)--Chinese University of Hong Kong, 2003.Includes bibliographical references (leaves 165-174).Abstracts in English and Chinese.ABSTRACT --- p.iiACKNOWLEDGEMENTS --- p.viiTABLE OF CONTENTS --- p.viiiLIST OF ABBREVIATIONS --- p.xiChapterChapter 1. --- Introduction --- p.1Chapter 2. --- Literature review --- p.10Chapter 2.1 --- Prescribing patterns of antibiotics in hospital --- p.12Chapter 2.2 --- Worldwide problem of misuse of antibiotics --- p.15Chapter 2.2.1 --- Misuse of antibiotics in developed countries --- p.15Chapter 2.2.1.1 --- The United States of America --- p.16Chapter 2.2.1.2 --- The United Kingdom --- p.19Chapter 2.2.1.3 --- Australia --- p.23Chapter 2.2.1.4 --- Canada --- p.25Chapter 2.2.2 --- Misuse of antibiotics in African countries --- p.27Chapter 2.2.3 --- Misuse of antibiotics in Asian countries --- p.30Chapter 3. --- Objectives --- p.37Chapter 4. --- Methods --- p.39Chapter 4.1 --- Subjects --- p.39Chapter 4.2 --- Data --- p.41Chapter 4.3 --- Definition of terms --- p.44Chapter 4.3.1 --- Name of antibiotic --- p.44Chapter 4.3.2 --- Antibiotic course and antibiotic therapy --- p.44Chapter 4.3.3 --- Indications and types of antibiotic therapy --- p.47Chapter 4.3.4 --- Switch therapy --- p.50Chapter 4.3.5 --- Types of change --- p.50Chapter 4.3.6 --- Causes of change --- p.51Chapter 4.3.7 --- Clinical outcome of treatment --- p.53Chapter 4.3.8 --- Length of stay --- p.54Chapter 4.4 --- Determination of pattern of use --- p.54Chapter 4.5 --- Assessment of antibiotic therapies --- p.55Chapter 4.5.1 --- Assessment of indication and choice of agent --- p.59Chapter 4.5.2 --- Assessment of dosage --- p.60Chapter 4.5.3 --- Assessment of route of administration --- p.62Chapter 4.5.4 --- Assessment of duration of therapy --- p.62Chapter 4.6 --- Features of the guideline developed for the present study --- p.63Chapter 4.6.1 --- Ceftriaxone and cefotaxime are appropriate for treating serious infections --- p.72Chapter 4.6.2 --- Cefuroxime is not a first line agent --- p.72Chapter 4.6.3 --- Regimen for Helicobacter pylori eradication --- p.73Chapter 4.7 --- Statistical analysis --- p.73Chapter 5. --- Results --- p.74Chapter 5.1 --- Antibiotic courses and patients --- p.74Chapter 5.1.1 --- Inclusion and exclusion of antibiotic courses --- p.74Chapter 5.1.2 --- Patient sex and age --- p.76Chapter 5.1.3 --- Chronic disease/past medical history --- p.76Chapter 5.1.4 --- Length of stay --- p.78Chapter 5.2 --- Pattern of use --- p.79Chapter 5.2.1 --- Indications and sites of infection --- p.79Chapter 5.2.2 --- Types of antibiotic therapy --- p.83Chapter 5.2.3 --- Antibiotics prescribed in initial therapy --- p.84Chapter 5.2.4 --- Number of antibiotics in initial therapy --- p.87Chapter 5.2.5 --- Prescribing pattern of antibiotics in initial therapy --- p.88Chapter 5.2.5.1 --- Prescribing pattern of antibiotics in empirical treatment of lower respiratory tract infections --- p.89Chapter 5.2.5.2 --- Prescribing pattern of antibiotics in empirical treatment of sepsis --- p.90Chapter 5.2.6 --- Types of change --- p.92Chapter 5.2.7 --- Causes of change --- p.92Chapter 5.2.8 --- The relationship between causes of change and types of change --- p.93Chapter 5.2.9 --- Antibiotics prescribed in switch therapy --- p.96Chapter 5.2.10 --- Number of antibiotics in switch therapy --- p.99Chapter 5.3 --- Appropriateness of antibiotic therapy --- p.100Chapter 5.3.1 --- Appropriateness of empirical therapies --- p.101Chapter 5.3.2 --- Appropriateness of directed therapies --- p.102Chapter 5.3.3 --- Appropriateness of prophylactic therapies --- p.103Chapter 5.3.4 --- Appropriateness of unclassified therapies --- p.104Chapter 5.4 --- Clinical outcomes of treatment --- p.105Chapter 6. --- Discussion --- p.106Chapter 6.1 --- Limitations --- p.106Chapter 6.2 --- Method --- p.110Chapter 6.2.1 --- Symptom improved and not responded --- p.110Chapter 6.2.2 --- Grand round --- p.111Chapter 6.2.3 --- Susceptibility test result --- p.111Chapter 6.3 --- Results --- p.112Chapter 6.3.1 --- Patients --- p.112Chapter 6.3.2 --- Pattern of use --- p.113Chapter 6.3.2.1 --- Types of therapy --- p.113Chapter 6.3.2.2 --- Site of infection --- p.113Chapter 6.3.2.3 --- Prescribing pattern of antibiotics in initial therapy --- p.114Chapter 6.3.2.4 --- Relationship between types and causes of change --- p.115Chapter 6.3.3 --- Appropriateness of antibiotic therapies --- p.117Chapter 6.3.3.1 --- Misuse of empirical therapy --- p.118INAPPROPRIATE USE OF ANTIBIOTICS IN LOWER RESPIRATORY TRACT INFECTION --- p.118INAPPROPRIATE USE OF ANTIBIOTICS IN SEPSIS --- p.120MISUSE OF CEFUROXIME --- p.122MISUSE OF THIRD GENERATION CEPHALOSPORIN --- p.127Chapter 6.3.3.2 --- Appropriate use of directed therapy --- p.129Chapter 6.3.3.3 --- Appropriate use of prophylactic therapy --- p.130Chapter 6.3.3.4 --- Excessive use of unclassified therapy --- p.131Chapter 6.3.4 --- Clinical outcome of treatment --- p.133Chapter 6.4 --- Conclusion --- p.134Chapter 7. --- Summary --- p.136Chapter 8. --- Recommendations --- p.140APPENDICES --- p.143Chapter 1. --- Usual adult daily dose range of antibiotics --- p.144Chapter 2. --- Assessment of indications and choices of agent of initial therapies in an audit of 324 antibiotic courses in a medical ward --- p.146Chapter 3. --- Culture test results in an audit of use of antibiotics in a medical ward --- p.160Chapter 4. --- Generic to trade name conversion of antibiotics --- p.163REFERENCES --- p.16