Proceedings of the dutch society for clinical pharmacology and biopharmacy

Results: During the baseline period, the antibiotic therapy of 77 surgical and 32 internal medicine patients was reviewed. On average, the pharmacist re-evaluated the choice of antibiotics three times during the course of treatment. On the surgical wards optimal treatment was achieved in 42% of scored therapies. The most frequent deviations were 1) choice of antibiotics (28%) and 2) route of administration (14%). On the internal medicine ward 51% of reviewed therapies met all criteria. The deviations on this ward were evenly spread. In the intervention period, 64% of scored therapies in the surgical versus 77% in the internal medicine wards were classified as optimal. All evaluated parameters improved. In both departments, deviations from the formulary were mainly caused by reluctance to use intravenous gentamicin. This could not be altered by the aforementioned interventions and influenced the outcome.