The Role of Pharmacists in Perioperative Antibiotic Application in a Hospital of Traditional Chinese Medicine (TCM)

Ruifang Xie, Zhicheng Li, Lingqi Zhu, Yun Zhang, Jie Shen, Xin Zhou

Department of Pharmacy, Longhua Hospital Affliated to Shanghai University of Tradtional Chinese Medcine, Shanghai, China.
Surgery Department, Shanghai Pudong Hospital, Shanghai, China.

DOI: 10.4236/pp.2014.53030                

Abstract

Objective: To determine adherence to Chinese guidelines for perioperative antibiotic use in our hospital of TCM and discuss the role of pharmacists on antibiotic management. Methods: 2844 operative cases between May 2011 and December 2011 in our hospital were investigated by pharmacists and relative data were collected, including demographic data, type of surgery, wound classification (clean and clean contaminated) and parameters of antibiotic application (antibiotic choice, route, dose, time of first dose, time of operative re-dosing and duration of prophylaxis). The rationality of antibiotic administration in these cases was respectively evaluated based on Chinese guidelines for perioperative antibiotic use. Results: After intervention of pharmacists, perioperative antibiotic application in our hospital was obviously improved from May to December of 2011: the rates of antibiotic application in operative cases and antibiotic prophylaxis in clean operation were both decreased. However, there was no significant improvement for the rate of rationality. In detail, TCM surgery was well compliant with the guidelines: the rate of antibiotic application was less than 30%, regimen of antibiotic prophylaxis and therapy was reasonable; in the breast ward, antibiotic application was improved after pharmacists’ intervention: the rate of antibiotic prophylaxis in clean operation significantly decreased from 100% to 30%; however, in the anorectal ward, some troubles were resolved while other new problems came out; in other ward such as general surgery and orthopedics, old problems still existed. Conclusions: Protocol violations were frequent to perioperative antibiotic application in our hospital due to considerable over prescription. Intervention was effective but not enough. Further educational strategies are essential for reducing costs and antibiotic resistance rates.

Keywords

Adherence; Perioperative Antibiotic Application; Intervention

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Gagliardi, A.R., Fenech, D., Eskicioglu, C., et al. (2009) Factors Influencing Antibiotic Prophylaxis for Surgical Site Infection Prevention in General Surgery: A Review of the Literature. Canadian Journal of Surgery, 52, 481-489.
[2]	Stermitz, F.R., Lorenz, P., Tawara, J.N., et a1. (2000) Synergy in a Medicinal Plant: Antimicrobial Action of Berberine Potentiated by 5’-Methoxyhydnocarpin, a Multidrug Pump Inhibitor. PNAS, 97, 1433-1437.
[3]	Cai, Y., Xing, Y. and Xie, W.G. (2011) Rearch on Progress of Antibacterial Activity of Chinese Medicine. China Medical Herald, 8, 9-10.
[4]	Kwan, H.A., Kwon, Y.-J., Kwon, D.-Y., et al. (2008) Evaluation of Antibacterial Effects of a Combination of Coptidis Rhizoma, Mume Fructus, and Schizandrae Fructus against Salmonella. International Journal of Food Microbiology, 127, 180.
[5]	Jayampath Seneviratne, C., Ricky, W.K.W. and Lakshman, P.S. (2008) Potent Anti-Microbial Activity of Traditional Chinese Medicine Herbs against Candida Species. Mycoses, 51, 30-34.
[6]	Tourmousoglou, C.E., Yiannakopoulou, E.C., Kalapothaki, V., et al. (2008) Adherence to Guidelines for Antibiotic Prophylaxis in General Surgery: A Critical Appraisal. Journal of Antimicrobial Chemotherapy, 61, 214-218.
[7]	Nicaragua, J., Disseldorp, V., Slingenberg, E.J.M.H., et al. (2006) Application of Guidelines on Preoperative Antibiotic Prophylaxis in León. The Netherlands journal of medicine, 64, 411-416.
[8]	Enzler, M.J., Berbari, E. and Osmon, D.R. (2011) Antimicrobial Prophylaxis in Adults. Mayo Clinic Proceedings, 86, 686-701.
[9]	Velmahos, G.C., Toutouzas, K.G., Sarkisyan, G., et al. (2002) Severe Trauma Is Not an Excuse for Prolonged Antibiotic Prophylaxis. Archives of surgery, 137, 537-542.
[10]	Dechiara, S., Chiumello, D., Nicolini, R., et al. (2010) Prolongation of Antibiotic Prophylaxis after Clean and Clean-Contaminated Surgery and Surgical Site Infection. Minerva Anestesiologica, 76, 413-419.