Estudo das prescrições de antimicrobianos para pacientes idosos hospitalizados sob a perspectiva do uso racional de medicamentos

Abstract

The World Health Organization (WHO) established: “Rational drug use occurs when patients receive medicines appropriated to their clinical needs, in doses that meet their individual requirements, for an adequate period of time, and at the lowest cost to them and their community”. One of the greatest world concerns in this context is the inadequate use of antibiotics that increase both microbial resistance and the costs elevation of health system. This observational transversal study investigated antibiotic prescriptions in Sentinels Hospitals from 210 patient’s charts of elderly patients (with 60 years old or more) which were hospitalized and submitted to antibiotic therapy. The predominance of respiratory infections (67 patient charts) between May, 2007 and March, 2008 was verified. Tendencies of these antibiotic prescriptions were identified in hospitals such as the frequencies for respiratory infections, the antibiotic groups prescribed and the triggering factors to the irrational use of these medicines. The predominance was observed in the male gender and in the age bracket of 80 or more years old. Beta-lactamics and quinolons were the most prescribed ones. Drugs were classified as belonging or not to the RENAME (National Relation of Essential Drugs) as a rational use criterion. The empiric use was responsible for 93% of the prescriptions; biological material was collected in only 21 patients. In 5 patients, microorganisms were isolated and the Antibiotic Susceptibility Test was performed (7%). Staphylococcus aureus, Enterococcus faecalis and Pseudomonas aeruginosa were the most frequently isolated ones. Amongst the isolated microorganisms, potentially or knwon multiresistant organisms were verified. Pneumonia and chronic pulmonary obstructive disease (CPOD) were the most frequent diagnosis registered. The distributions of patients were established using the number of active principles, pharmaceutical specialty, treatment duration, daily dose and route of administration. An association including as much as 8 active principles was found, but monotherapy was predominant (39%). The association of 2 active principles was observed in 34% of patients. Active principles with possible antagonic therapeutic action were associated in 28%. Intravenous route was the most used one (78%). In 30% of the patient’s charts, the daily doses were different from the usual ones. Variability concerning duration of treatment was evidenced, suggesting that the absence of patterns or non-use of prescription protocols. The dearth of general information registries in the patient’s chart was verified. The study demonstrated the need of interventions able to assure that people meet the protocols as a way of guarantee the adequate use of antibiotics, the establishment of strategies and conduct guidelines directed to certain groups of antibiotics and to geriatric patients; and the action integration between hospital infection control and the pharmaceutical service.