Branislava Popović

Assessment of adherence to printed guidelines for antimicrobial drug use in a university hospital

Objectives To assess the quality of antimicrobial prescribing and the level of adherence to the guidelines in the department of medicine at a university hospital. Methods A point prevalence survey was conducted between September 2008 and May 2011 at four selected time points. Demographic and relevant clinical patient data for those receiving antibiotic treatment were recorded. The necessity of antimicrobial treatment was assessed according to a scoring system based on the presence of signs and symptoms of an infection. Antibiotic use was judged according to Guidelines for hospital antimicrobial drug use published in December 2008. Results The percentage of patients receiving antimicrobials varied from 30.8% (N=73) (September 2008) to 25.1% (N=60) (May 2011). At the first time point, 37.3% (N=25) of patients received antimicrobial therapy that was not necessary significantly more often than at other time points (p<0.01). Level of adherence to the guidelines varied between 35.0% (April 2009) and 50.0% (May 2011). The highest level of non-compliance with the guidelines was observed when cefuroxime, ceftriaxone and ciprofloxacin were prescribed. Conclusions Our study demonstrates a continuous overuse of broad-spectrum antibiotics. A decrease in unnecessary antibiotic use and an increase in treatments based on susceptibility testing were noted in the periods when the guidelines were in use. This speaks in favour of guidelines for antimicrobial treatment being a valuable part of antimicrobial stewardship programmes.

Outcome of treatment with antidepressants in patients with hypertension and undetected depression

Objective: The objective of the research was to determine whether the administration of antidepressants, concurrently with antihypertensive therapy, leads to the better regulation of blood pressure in patients with hypertension and increased depressiveness. Methods: Research was conducted in two outpatient family clinics in Rijeka, Croatia, on 452 patients with arterial hypertension who had not been diagnosed with depression prior to the study. The diagnosis of hypertension was made in accordance with the European Society of Hypertension and the European Society of Cardiology Guidelines for the Management of Arterial Hypertension. Using the Beck Depression Inventory and the ICD-10 criteria for depression, a group of depressed hypertensive patients (N = 134) was selected. Out of a total of 134 selected patients, 73 patients (N = 73) were receiving antidepressants together with antihypertensives for 24 weeks. They formed the experimental group. The rest of the patients (N = 61) continued to receive only antihypertensives and they formed the control group. Results: After the end of the 24-week therapy, the experimental group of patients had significantly lower levels of both systolic and diastolic blood pressure (Z = 7.42; P < 0.001; and Z = 7.36; P < 0.001). The control group saw no significant difference between the level of blood pressure (both systolic and diastolic) prior to and after this period. Conclusion: The application of antidepressant therapy in patients with hypertension who are also depressed may be associated with the better control of blood pressure, which reduces the risk of cardiovascular disease in addition to alleviating depressive symptoms.