Background: Colistin, is used as the last treatment line for infections concluded from multiple DRUG-resistant gram-negative microorganisms. Increased consumption of colistin leads to resistance to this antibiotic in many countries. This study investigated the usage pattern of colistin administration in a selected hospital in Iran. Methods: This study was conducted in a selected hospital in Ahvaz. Inclusion criteria were all patients who received colistin during this time according to the health information system. Patients who were received less than three doses of colistin were excluded from the study. Prescription of colistin in all patients was evaluated according to the protocol extracted from the last version of Lexicomp written by Wolters Kluwer. The descriptive and analytical statistics were carried out by the R software. Results: Among 27 patients who received colistin, pneumonia (30%) was the main diagnoses. Colistin administration was based on the microbiological culture data in 70% of cases. Considering the involved microorganism, most cases were Acinetobacter spp., followed by Klebsiella spp. Loading dose was prescribed for seven (26%) patients. In only five (19%) cases, colistin dosing, including loading dose, maintenance dose, and the interval of colistin administration, was appropriate during the study time. Increasing in serum creatinine was seen in two (7. 4%) patients. In 29. 4% of patients, the combination of colistin and carbapenems was observed. Conclusion: Given the lack of appropriate dose adjustment of colistin that may lead to incidence of resistance and adverse effect, applying of the specialist clinical pharmacist will be suggested.

Background: Increasing reports of Vancomycin resistance have raised concerns about effectiveness of this DRUG. One of the most important factors of resistance emergence is no adherence of physician to principles of antibiotic therapy. This study is a DRUG UTILIZATION EVALUATION (DUE) of Vancomycin in pediatric ward to assess appropriateness of DRUG regimens and to find possible problems in clinical practices that may necessitate reconciliation to improve Vancomycin use. Materials and Methods: This prospective study was done for 1year from October 2014 to September 2015 at Khalij Fars General Hospital in Bandar Abbas. Data including patients’ demographics, paraclinic, diagnosis, vancomycin dose, and treatment duration were collected. The concordance of practice with standard guidelines (CDC, ASHP, and IDSA) and principles of antibiotic therapy was assessed. Results were analyzed by SPSS 20. Results: 102 medical records were reviewed in this study. Pneumonia (60=59%) and sepsis (22=21. 5%) were the most common diagnosis. Sampling was done in 6% of patients with 2% antibiogram. Vancomycin was administered appropriately in 56. 9% percent of patients with no sex difference (PV= 0. 55) but age with significant difference (PV= 0. 017). Over use was in a great proportion of patients (36cases=35%) as unnecessary, improper combination and broad spectrum regimen. Conclusion: Vancomycin was overused irrationally in a great proportion of patients. There was no serum level monitoring. Microbial resistance, serum trough level monitoring programs and continuous medical education for physicians can be effective in rational use of antibiotic.

The goal of this study was to evaluate the quality of warfarin UTILIZATION in three teaching hospitals of Isfahan.We did a cross sectional retrospective study of 300 medical charts of patients who had received warfarin during their hospitalization. A data collection form was designed as well as an indication list with the threshold limits set using various related articles.The indicators representing the starting dose, the maintenance dose, the patient's PT/INR two days before discharge, the starting day of warfarin relative to heparin and DRUG interactions were all below our accepted limits and percentage of cases with hemorrhage was above our accepted limit. Therefore, the physicians' performance in different aspects of warfarin management needs improvement.

Introduction: DRUG UTILIZATION EVALUATION (DUE) studies are designed to assess DRUG usage appropriateness. DUEs have traditionally focused on DRUGs with high price tags, complicated dosage schedules, narrow therapeutic indices and regular side effects. The primary goal of the present study is to evaluate imipenem usage in Bone Marrow Transplantation (BMT) wards.Methods: The study was a prospective DUE study, carried out in three BMT wards in Dr. Shariati hospital, Hematology- Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences. The study was performed from April 2008 to October 2008. NCCN Clinical Practice Guidelines in Oncology and AHFS recommended protocols were used for EVALUATION. For a statistical analysis, SPSS (version 16.0) was used.Results: A total of 64 patients were evaluated during the study. In all patients, imipenem was started empirically. In thirty five (54.7%) patients, the antibiotic seemed to be effective. Twenty- two (35.9%) patients needed dosage adjustments due to low weight or renal failure, but no action in this regard was taken. In 51.6% of patients, the antibiotic therapy duration was not appropriate. Thirty seven (57.8%) patients experienced nausea.Conclusion: Imipenem in febrile neutropenic patients is administered empirically. Imipenem induced nausea was observed in 57.8% of patients. This result may be due to rapid infusion of imipenem in the wards. The result of this study indicates the need for further education on dosage adjustment based on renal function and patients’ weight.Improper duration of the treatment could result in resistance and thus should be noted.

Background: Carbapenems are beta-lactam antibiotics with broad-spectrum activity for Gram-positive, Gram-negative and anaerobic bacteria and have become the antibiotics of last resort for many serious bacterial infections. The irrational use of carbapenems (imipenem or meropenm) has increased the risk of multi-DRUG resistant pathogens. The aim of this study was to evaluate the pattern of carbapenem UTILIZATION within 9 months and measure compliance with references in Imam Reza Hospital, Tabriz, Iran. Methods: During 9 months, 100 patients who received carbapenems randomly get selected under the supervision of the attending physician in Imam Reza Hospital affiliated to the Tabriz university of Medical sciences. After coordination with supervisor of each ward, the necessary information was extracted and American Hospital Formulary System (AHFS) and UpToDate 21. 3 references were used to assess appropriate indication and accurate dosage of carbapenems. Results: : The most common cause of prescribing was lower respiratory tract infection (29%). Carbapenems were prescribed for 64% of patients as an appropriate indication. The dose of carbapenems was correct in 74% of patients and duration of carbapenems therapy was correct in 84% of cases. Dose readjustment was necessary for 28 patients, although for 25 of whom it was performed. Only 19 patients had positive culture results. Conclusion: Despite the global guidelines, carbapenem consumption in health care systems is incorrect. So, comprehensive programs for rational DRUG use in all medical centers conducted by a clinical pharmacist seems necessary to be employed.

DRUG UTILIZATION EVALUATION (DUE) studies are designed to assess DRUG usage appropriateness. We aim to evaluate the DRUG UTILIZATION of intravenous ciprofloxacin and imipenem, two of the broad spectrum antibiotics that consume a significant proportion of our hospitals’ outlay, in different wards of a teaching hospital in Zabol. During a 5 months period (December 2010 to May 2011), 263 patients who received imipenem or intravenous ciprofloxacin were assigned to this study. Retrospective review of patient’s records was carried out. Data were converted to Defined Daily Dose (DDD) and the ratio of prescribed daily dose per DDD was calculated. Among these records, 100 patients received either imipenem or ciprofloxacin. The ratio of prescribed daily dose to DDD was 1.5 for both antibiotics. Almost all patients received empiric therapy in both groups. Only 13 patients (26%) in ciprofloxacin group and 4 patients (8%) in imipenem group received their antibiotics consistent with American Hospital Formulary System (AHFS) mentioned indication. Baseline Blood Urea Nitrogen (BUN) and serum Creatinine were ordered for only 37 patients (74%) in both groups with 15 abnormal results but dose adjustment performed just in one case with decreased renal function. In conclusion, the majority of courses with both DRUGs were empirically selected and continued and required lab tests for DRUG monitoring and dose adjustments were not performed in most cases. Educational interventions, developing a local formulary and a strict antibiotic prescribing policy for example by prior approval by an infectious disease consultant can help significantly to overcome these problems.

Background and purpose: This study aimed at evaluating UTILIZATION of imipenem and assessing the role of pharmacist in rational use of antibiotics. Materials and methods: A retrospective/prospective observational study was conducted in Ramsar Imam Sajjad Hospital in 59 patients receiving imipenem, 2018-2019. In retrospective phase, patients’ records were reviewed, while in prospective phase, a pharmacist provided recommendations on use of imipenem. Duration of taking imipenem, dosage, and dosage adjustment in renal insufficiency were compared with standard protocols. Results: Mean age of the patients was 69. 89± 16. 12 years and there were 29 males. The most common reason for prescribing imipenem was lower respiratory tract infection (54%) which was more used in internal medicine ward (67. 28%) ordered by infectious diseases specialist (65%). In retrospective and prospective phases, mean dosage of imipenem, duration of receiving the antibiotic, and dosage adjustment in renal insufficiency were according to standard protocols in 65% and 85%, 45% and 65%, and 60% and 90% of the cases, respectively (P<0. 001). Conclusion: The role of pharmacist in DRUG UTILIZATION EVALUATIONs is of great importance for optimal use of DRUGs and reducing mortality rates caused by infectious diseases.

Background: DRUG UTILIZATION EVALUATION (DUE) studies are performed to define, determine, and finally improve the quality of DRUG usage. These types of studies are especially valuable for DRUGs with a narrow therapeutic index or specific indication, or for expensive medications. In Iran, vancomycin is only available by prescription for methicillin-resistant staphylococcal and enterococcal infections. It is obvious that extensive and irrational use of this DRUG can increase bacterial resistance to this antibiotic. The goal of this study was to assess vancomycin UTILIZATION.Methods: In a descriptive cross-sectional study performed during the fall and winter of 2004, this vancomycin DUE was done in the Infectious Disease Department of Imam Khomeini Hospital in Tehran. All of the patients receiving vancomycin were enrolled in this study. The Centers for Disease Control (CDC) and American Society of Hospital Pharmacists (ASHP) protocols have been used to perform this study.Results: Of the 565 inpatients at this hospital, 39 subjects (7%) received vancomycin. Vancomycin UTILIZATION among these patients was compatible with CDC and ASHP protocols in only 28% and 35% of the patients, respectively.Conculusion: Vancomycin is predominantly administered empirically, rather than being based on the antibiogram. This may be due to the routine protocol of the ward or the physician doubting the reliability of the antibiogram.