단일 대학병원 폐렴 입원환자의 Levofloxacin 사용 적정성 평가
Evaluation of Levofloxacin Use in Pneumonia Inpatients in a Hospital
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Background : Despite recent advances in diagnosis and treatment, pneumonia causes great morbidity and mortality and entails high healthcare costs. Levofloxacin is one of the recommended drugs for the treatment of pneumonia. However, the increase in the use of levofloxacin may lead to an increase in resistance to this medication. The purpose of this study was to evaluate the rate of levofloxacin use to prevent resistance to the drug as per the developed criteria (referenced with Micromedex®, KIMS® and KFDA) and to provide information for implementation of pharmaceutical intervention for the optimal intravenous-to-oral (IV-to-PO) switch. Methods : This study was conducted within pneumonia patients discharged from the pulmonology ward at the Ulsan University Hospital June 1, December 31, 2018. The evaluation criteria were as follow: treatment dose, duration of the treatment, potential drug-drug interactions (pDDIs), evaluation of implementation of essential examinations and adverse drug reaction (ADR) monitoring, and the optimal IV-to-PO switch. The electronic medical record (EMR) database was used to retrospectively collect data. Results : In total, 125 patients were included, of whom 17 were later excluded from the evaluation of the treatment period, and optimal IV-to-PO switch from death during the treatment. Dose adjustment according to renal function was required in 59 (47.2%) patients, four of whom received a suitable dose. The treatment period was appropriate in 66.7% patients. Also, 34.4% patients did not receive concomitant drugs that could interact with levofloxacin, and the implementation rate of essential examination was high except for therapeutic drug monitoring. Additionally, 46.3% of patients were suitable for the optimal IV-to-PO switch. Although no ADRs were reported during ADR monitoring, several symptoms including itching, and elevated LFT were recorded by the EMR. Conclusion : Through evaluating of use of levofloxacin in pneumonia patients, we confirmed that practical mediation by pharmacists and improvement of the system are necessary.
Abstract
Background : Despite recent advances in diagnosis and treatment, pneumonia causes great morbidity and mortality and entails high healthcare costs. Levofloxacin is one of the recommended drugs for the treatment of pneumonia. However, the increase in the use of levofloxacin may lead to an increase in resistance to this medication. The purpose of this study was to evaluate the rate of levofloxacin use to prevent resistance to the drug as per the developed criteria (referenced with Micromedex®, KIMS® and KFDA) and to provide information for implementation of pharmaceutical intervention for the optimal intravenous-to-oral (IV-to-PO) switch. Methods : This study was conducted within pneumonia patients discharged from the pulmonology ward at the Ulsan University Hospital June 1, December 31, 2018. The evaluation criteria were as follow: treatment dose, duration of the treatment, potential drug-drug interactions (pDDIs), evaluation of implementation of essential examinations and adverse drug reaction (ADR) monitoring, and the optimal IV-to-PO switch. The electronic medical record (EMR) database was used to retrospectively collect data. Results : In total, 125 patients were included, of whom 17 were later excluded from the evaluation of the treatment period, and optimal IV-to-PO switch from death during the treatment. Dose adjustment according to renal function was required in 59 (47.2%) patients, four of whom received a suitable dose. The treatment period was appropriate in 66.7% patients. Also, 34.4% patients did not receive concomitant drugs that could interact with levofloxacin, and the implementation rate of essential examination was high except for therapeutic drug monitoring. Additionally, 46.3% of patients were suitable for the optimal IV-to-PO switch. Although no ADRs were reported during ADR monitoring, several symptoms including itching, and elevated LFT were recorded by the EMR. Conclusion : Through evaluating of use of levofloxacin in pneumonia patients, we confirmed that practical mediation by pharmacists and improvement of the system are necessary.
참고문헌 (30)
- Welte T, "Clinical and economic burden of community-acquired pneumonia among adults in Europe", Thorax, 67(1), pp.71~79 (2012)
- Jokinen C, "Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland", American Journal of Epidemiology, 137(9), pp.977~988 (1993)
- Prina E, "Community-acquired pneumonia", The Lancet, 386(9998), pp.1097~1108 (2015)
- Quintiliani R, "Clinical role of fluoroquinolones in patients with respiratory tract infections", Infectious Diseases in Clinical Practice, 8(4), pp.S28~41 (1999)
- Chen DK, "Decreased susceptibility of streptococcus pneumoniae to fluoroquinolones in Canada", New England Journal of Medicine, 341(4), pp.233~239 (1999)
- Mandell LA, "Canadian guidelines for the initial management of community-acquired pneumonia an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society", Clinical Infectious Diseases, 31(2), pp.383~421 (2000)
- 김의석, "Clinical Importance and Epidemiology of Quinolone Resistance", Infection and Chemotherapy, 46(4), pp.226~238 (2014), 대한감염학회[DOI]
- "성인지역사회 획득 폐렴 항생제 사용지침" (2017)[URL]
- Kim SH, "Changing trends in antimicrobial resistance and serotypes of Streptococcus pneumoniae isolates in Asian countries : an Asian Network for Surveillance of Resistant Pathogens(ANSORP)study", Antimicrobial Agents and Chemotherapy, 56(3), pp.1418~1426 (2012)
- Ho PL, "Risk factors for acquisition of levofloxacinresistant Streptococcus pneumoniae : a case-control study", Clinical Infectious Diseases, 32(5), pp.701~707 (2001)
- Davidson R, "Resistance to levofloxacin and failure of treatment of pneumococcal pneumonia", New England Journal of Medicine, 346(10), pp.747~750 (2002)
- Dellit TH, "Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship", Clinical Infectious Diseases, 44(2), pp.159~177 (2007)
- "제7차 한국표준질병사인분류" (2015)[URL]
- "Levofloxacin" (1987)[URL]
- "Levofloxacin" (2020)[URL]
- "항생제 스튜어드십 도입을 위한 가이드" (2018)[URL]
- "WHO Collaborating Centre for Drug Statistics Methodology ATC/DDD Index" (2018)[URL]
- Pillans PI, "Evaluation of dosage adjustment in patients with renal impairment", Internal medicine journal, 33, pp.10~13 (2003)
- Sweileh WM, "Medication dosing errors in hospitalized patients with renal impairment : a study in Palestine", Pharmacoepidemiology and drug safety, 16(8), pp.908~912 (2007)
- Schouten JA, "Barriers to optimal antibiotic use for community-acquired pneumonia at hospitals : a qualitative study", BMJ Quality & Safety, 16(2), pp.143~149 (2007)
- Salomon L, "Medication misuse in hospitalized patients with renal impairment", International Journal for Quality in Health Care, 15(4), pp.331~335 (2003)
- 최나이, "신기능 저하 환자의 약용량 조절 적절성 평가", 병원약사회지, 28(4), pp.356~363 (2011), 한국병원약사회[DOI]
- Drew BJ, "Prevention of torsade de pointes in hospital settings : a scientific statement from the American Heart Association and the American College of Cardiology Foundation endorsed by the American Association of Critical-Care Nurses and the International Society for Computerized Electrocardiology", Journal of the American College of Cardiology, 55(9), pp.934~947 (2010)
- Tisdale JE, "Drug-induced QT interval prolongation and torsades de pointes : role of the pharmacist in risk assessment, prevention and management", Canadian Pharmacists Journal, 149(3), pp.139~152 (2016)
- Tisdale JE, "Development and validation of a risk score to predict QT interval prolongation in hospitalized patients", Circulation : Cardiovascular Quality and Outcomes, 6(4), pp.479~487 (2013)
- Mertz D, "Outcomes of early switching from intravenous to oral antibiotics on medical wards", Journal of Antimicrobial Chemotherapy, 64(1), pp.188~199 (2009)
- Sevinç F, "Early switch from intravenous to oral antibiotics : guidelines and implementation in a large teaching hospital", Journal of Antimicrobial Chemotherapy, 43(4), pp.601~606 (1999)
- Rhew DC, "Early switch and early discharge strategies in patients with community-acquired pneumonia : a meta-analysis", Archives of internal medicine, 161(5), pp.722~727 (2001)
- Omidvari K, "Early transition to oral antibiotic therapy for community-acquired pneumonia : duration of therapy, clinical outcomes, and cost analysis", Respiratory Medicine, 92(8), pp.1032~1039 (1998)
- 김형숙, "항균제 관리팀에서 약사의 업무 개발 및 확대 방안", 병원약사회지, 35(1), pp.30~38 (2018), 한국병원약사회[DOI]