การใช้ยาปฏิชีวนะในผู้ป่วยโรคปอดบวมที่เกิดในชุมชนที่เข้ารักษาในโรงพยาบาลจุฬาลงกรณ์ / ปิลันธนา ปรัศว์เมธีกุล = Antibiotics utilization in community-acquired pneumonia inpatients at King Chulalongkorn Memorial Hospital / Pilunthana Prusmathekul
To assess the empirical treatment in community-acquired pneumonia (CAP), the causative pathogens and their susceptibility, and drug therapy problems (DTPs) in hospitalized patients with community-acquired pneumonia at King Chulalongkorn Memorial Hospital between October 2002 to February 2003. Fifty-seven CAP patients were recruited, the mean age was 58.6+-21.1 years and the median age was 65.0 years, 40.4% of patients received antibiotics prior to hospitalization, the mean duration of hospitalization was 8.6+-9.2 days and the median was 6.0 days. Fifty patients were cured and seven deaths because of their chronic diseases (4/7) and community-acquired pneumonia (3/7). Twenty-nine patients out of forty-four (65.9%) were followed up by the physician. The microbiologic testing revealed 68.4% sputum gram's stain, which gram positive diplococci were mostly found. Sputum bacterial cultures were sent 70.2%. The definite pathogens from blood cultures and sterile specimens were S. pneumoniae (40.0%) and Streptococcus gr.F (40.0%). The probable pathogen from serological method and polymerase chain reaction was M. pneumoniae. The possible pathogens that found mostly from sputum cultures were H. influenzae (27.3%), P. aeruginosa (18.2%) and E. coli (9.1%), respectively. The susceptibility tests of causative pathogens were: S. pneumoniae was susceptible to penicillin, vancomycin, cefotaxime and meropenem , Streptococcus gr.F was susceptible to penicillin, clindamycin, erythromycin, chloramphenicol, gentamicin, vancomycin, cefotaxime and meropenem, H. influenzae was susceptible to ampicillin, amoxicillin/clavulanate, ciprofloxacin, ceftriaxone, and imipenem, P. aeruginosa was susceptible to ciprofloxacin and E. coli was susceptible to gentamicin, sulperazon, tazocin, ceftriaxone, ceftazidime, imipenem, cefpirome, meropenem and cefepime. The mostly antibiotics had been used for empirical therapy were the third generation cephalosporins (33.3%), the third generation cephalosporins plus macrolides (19.3%) and macrolides (14.0%), respectively. The duration of antibiotics treatment was 14.6+-9.4 days and total cost of them were 6,086 baht per patient. Oral antibiotics for switch therapy were amoxicillin/clavulanate (21.7%) and cefdinir (21.7%). Drug therapy problems were occurred 21.0% that were: the patients were taking the inappropriate drug (33.3%) and the dosage was too high for the patients (33.3%). Although these DTPs had not changed the outcome of treatment but it was the pharmacist's role to monitoring and taking intervention with the physician to prevent these problems.
