Antibiotic consumption in five tertiary children's hospitals before and after implementation of guidelines for antibacterial use in clinical practice

Objective To investigate the pattern of antibacterial consumption in five tertiary children's hospitals from 2002 to 2006.To see if the Guidelines for antibacterial use in clinical practice have any impact on the use.Methods Five children's hospitals including Beijing Children's Hospital affiliated to Capital Medical University Beijing,Tianjin Children's Hospital of Tianjin Medical University,Children's Hospital of Fudan University,Chongqing Children's Hospital affiliated to Chongqing Medical University,Shanghai Children's Hospital affiliated to Shanghai Jiaotong University,Guangzhou Children's Hospital Affiliated to Guangzhou Medical College were chosen.The Anatomical Therapeutical Chemical Classification/Defined Daily Doses(ATC/DDD)methodology was used.Aggregate data on antibiotic use(ATC code-J01)were expressed in numbers of DDD/100 patient-days for outpatients and DDD/100 bed-days for inpatients.Antibiotic data were collected for systemic drug in number of packages and doses retrospectively from each hospital computer database for the entire year from 2002 to 2006.In October 2004,national Guidelines for antibacterial use in clinical practice were issued,which divided antibiotics into non-restricted,restricted and special use grades.The trend of DDDs was investigated before and after national Guidelines for antibacterial use in clinical practice were issued.Results ①In outpatient departments of five children's hospitals,the antibacterial consumption was different from each other.The overall antibiotic consumption decreased after the guideline was issued in some hospitals and the variation in antibiotic use between hospitals was also reduced.②A significant decrease in non-restricted antibiotics use was observed in outpatient departments of the five hospitals.Also the use of restricted antibiotics was reduced in two hospitals.However,a decrease in the use of first-generation cephalosporins,and an increase in the use of third-generation cephalosporins as well as in the combination of penicillins and β-lactamase inhibitors were observed in outpatient departments.③The overall use of antibiotic drugs of inpatients was 68.2,58.4,65.8,65.6 and 49.9 DDD/100 bed-days for the years 2002 to 2006,respectively.While the overall antibiotic use in 2005 was not greatly changed compared with previous years,by 2006 antibiotic use was decreased by 22.6% and the variation in antibiotic use among hospitals was also reduced.④The use of non-restricted grade antibacterials reduced one year after the guideline was issued and the use of restricted grade antibacterials remained stable.The antibiotic use may be improved because of the exchange in the top class from third-generation cephalosporins,Ceftriaxone and Cefoperazone to second-generation cephalosporins,Cefuroxime.Conclusions This multicentre survey on antibiotic use in five tertiary children's hospitals showed that the DDDs were relatively high and considerable variation both in the pattern and amount of antibiotics use could be found in each hospital.The differences of DDDs were observed among five children's hospitals.The decline in overall antibiotic use,especially in antibiotics of non-restricted grade,and variation in antibiotic use between hospitals may be attributed to the impact of national Guidelines for antibacterial use in clinical practice.The survey indicated that overuse of antibiotics might be reduced.To develop and implement guidelines is therefore crucial for rational use of antibiotics.