Avaliação do uso de antimicrobianos em um hospital universitário da cidade de Manaus - Amazonas

Abstract

The anti-microbial drugs were discovered in the 1940s. However, since there were no precise criteria for their use, there were already works proving the indiscriminate use these medicines in the 1970s and, currently, they are still the target of controversy in the scientific community. The anti-microbial medicines are among the most used drugs being used by physicians in the hospital institutions, with a large diversity of consequences. Among the consequences of their inadequate use are adverse reactions, appearance of resistant micro-organisms, and the predisposition to secondary infections, limiting the therapeutic possibilities and increasing both the mortality rates and the health service facility cost. Aiming to assess the use of anti-microbial drugs in a university hospital in the city of Manaus /AM, a retrospective study was carried out with 300 record log-sheets of patients admitted in the Intensive Care Unit from January 2000 to December 2004. The classification of the indications of the anti-microbial drugs was performed based on the antibiotic-prophylaxy and antibiotic-therapy routines of the Hospital Infection Control Commission and Health Ministry Consensus On the Anti-Microbial Drug Rational Use. A sub-sample of 40 record log-sheets, whose patients shared common characteristics, was removed in order to verify the correlation between the anti-microbial drug improper use and time of admission, outpatient condition, and hospital costs. Of the 300 record log-sheets analysed, 253 (84.3%) patients had proper indication of the anti-microbial drugs, whereas 47 (15.7%) were making use of them in an irrational manner. As far as the hospital infection is concerned there is an association of the irrational use of anti-microbial drugs with the development of those infections. Analyses of the 40 record log-sheet sub-sample revealed that the improper use increases the patient’s time of admission and raises the hospital costs substantially. Hence, the improvement on the prescription standard of these medicines may be achieved through primary activities, such as continued education of the medical staff for their rational use, the regular monitoring of the resistance/susceptibility profile of the germs to those products and their standardisation and control