The Pharmaceutical Journal
Vol 273 No 7307 p53
10 July 2004

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· Pharmacy education
· St John's wort
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· Antimicrobial resistance
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Letters to the Editor

Antimicrobial resistance

Overwhelming need for national data collection

From Mr C. E. Curtis, MRPharmS

The News feature “How to promote rational antibiotic use” (PJ, 3 July, p10) highlighted the forthcoming conference to promote the rational use of antimicrobials in acute care and the role that pharmacists can play. Although I fully endorse the comments of Jonathan Cooke with regard to data collection, great caution will be required in any interpretation of antibiotic usage figures. The number of defined daily doses prescribed for each antibiotic is the crucial first step and this should be provided by all acute hospitals. The denominator is more problematic and although the 100 bed days favoured by the World Health Organization is useful as a comparator between hospitals and also internationally, there are a number of factors which can influence the results.

I have been working to demonstrate the utility of the FCE (finished consultant episode) as an alternative denominator. This is influenced less by decreases in length of patient stay for hospital treatment. Results from ongoing work show year on year decreases in total antibiotic prescribing rates for 2001–02 and 2002–03 in a sample group of hospitals when the FCE is used as a denominator whereas, when the 100 bed day is used, there is a year on year increase in total antibiotic usage.

There are also other influences at work, such as individual hospital case mix and variations in the morbidity of the hospital catchment population, which will affect the amount of antibiotic prescribed. It will be important that great care is taken when interpreting individual hospital antibiotic prescribing rates and account taken of some of the factors which can influence the results.

The need for a national data collection programme is overwhelming in the light of increasing antimicrobial resistance levels and I welcome the first steps on the path to creating such a resource.

Chris Curtis
Head of Pharmaceutical Services
Burton Hospitals NHS Trust

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