The Antimicrobial Dosage Adjustment for Inpatient with Renal Impairment in Maharaj Nakhon Si Thammarat Hospital

Abstract

Background: Patients with e-GFR <60 ml/min/1.73 m² must be reviewed for antimicrobial dosage adjustment in Maharaj Nakhon Si Thammarat Hospital for patients safety with medication use.

Objectives: 1) To study the percentage of antimicrobial dosage adjustment for inpatients with e-GFR <60 ml/min/1.73 m²according to renal function conditions by referring to the guidelines for the antimicrobial dosage adjustment in patients with renal impairement,
Maharaj Nakhon Si Thammarat Hospital  2) to study the cost of antimicrobial compared when the doses were adjusted and not to be adjusted for in-patients with renal impairement that monitoring e-GFR <60 ml/min/1.73 m.²

Materials and Methods: To review of history of antimicrobial use from medical records and database in program HOS4, Maharaj Nakhon Si Thammarat Hospital. Data were collected from April 2019 until September 2019 in patients aged 18 years and more who were hospitalized at Maharaj Nakhon Si Thammarat Hospital, who received antimicrobial and monitored the e-GFR value <60 ml/min/1.73 m² at least 1 time while admission.

Results: From the research, it was found that patients in Maharaj Nakhon Si Thammarat Hospital received antimicrobial dosage orders in patients with renal impairment. e-GFR <60 ml/min/1.73 m², representing 94.19%. (778/826 cases) 1) Patients received an appropriate dose of antimicrobial  adjusted to 79.89 percent (9,953 / 12,459 times)  2) The cost of antimicrobial ​​when adjusting the dose compared to not adjusting the dose were 141,922.46 baht and 232,757.52 baht respectively, expected to decrease by 39.02 percent as 90,835.06 baht.

Conclusions: The multidisciplinary team should be aware of the appropriate antimicrobial dosage adjustment for each patient. To ensure the safe of medication use resulting in reducing medication cost in the hospital.