Cefepime 약물 사용 평가
Drug Use Evaluation of Cefepime
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Cefepime is fourth generation class, broad-spectrum cephalosporin. In contrast to older cephalosporins, cefepime penetrates the gram-negative cell more rapidly, targets multiple essential penicillin-binding proteins, and escapes the effects of many beta-lactamases due to the enzymes’ low affinity for the drug. However, it should be used judiciously because unnecessary, improper, and prolonged use may lead to the emergence of cefepime-insensitive bacteria and risk decline in its efficacy. Therefore, this study was performed to evaluate the use of cefepime and its efficacy. We retrospectively analyzed medical records of patients who received cefepime at Chonbuk National University Hospital, from January 2011 to July 2011. As a result, 169 cases were studied; the justification of use showed a high rate of appropriate use 161 cases(95.3%). A majority of the critical(process) indicators also showed a high rate of appropriate use 126~164 cases(74.6~100%). The dosage of cefepime was appropriate in 122 cases(72.2%). Duration of therapy was appropriate in 100% of patients with neutropenia, but other cases were lower. Complications occurred in 35 cases, including nephrotoxicity(9 cases), hepatotoxicity(4 cases), gastrointestinal effects(8 cases), hematologic effects(5 cases), fever(3 cases), skin reactions(5 cases) and neurotoxicity(1 case). In outcome measures, the total therapeutic response rate showed 60.9%. Cefepime was being used for appropriate reasons, but it was not being well monitored. Since the improper use of antibiotics can lead to an increase of multidrug-resistant bacterias, increased safety measures could be taken by authorized clinical pharmacists to prescribe antibiotics for proper use and ongoing monitoring. Additional studies will also need to be considered for a wider variety of clinical data.
Abstract
Cefepime is fourth generation class, broad-spectrum cephalosporin. In contrast to older cephalosporins, cefepime penetrates the gram-negative cell more rapidly, targets multiple essential penicillin-binding proteins, and escapes the effects of many beta-lactamases due to the enzymes’ low affinity for the drug. However, it should be used judiciously because unnecessary, improper, and prolonged use may lead to the emergence of cefepime-insensitive bacteria and risk decline in its efficacy. Therefore, this study was performed to evaluate the use of cefepime and its efficacy. We retrospectively analyzed medical records of patients who received cefepime at Chonbuk National University Hospital, from January 2011 to July 2011. As a result, 169 cases were studied; the justification of use showed a high rate of appropriate use 161 cases(95.3%). A majority of the critical(process) indicators also showed a high rate of appropriate use 126~164 cases(74.6~100%). The dosage of cefepime was appropriate in 122 cases(72.2%). Duration of therapy was appropriate in 100% of patients with neutropenia, but other cases were lower. Complications occurred in 35 cases, including nephrotoxicity(9 cases), hepatotoxicity(4 cases), gastrointestinal effects(8 cases), hematologic effects(5 cases), fever(3 cases), skin reactions(5 cases) and neurotoxicity(1 case). In outcome measures, the total therapeutic response rate showed 60.9%. Cefepime was being used for appropriate reasons, but it was not being well monitored. Since the improper use of antibiotics can lead to an increase of multidrug-resistant bacterias, increased safety measures could be taken by authorized clinical pharmacists to prescribe antibiotics for proper use and ongoing monitoring. Additional studies will also need to be considered for a wider variety of clinical data.
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