Drug Utilization Evaluation of Imipenem in Patients Undergoing Bone Marrow Transplantation

Abstract

Introduction: Drug Utilization Evaluation (DUE) studies are designed to assess drug usage appropriateness. DUEs have traditionally focused on drugs with high price tags, complicated dosage schedules, narrow therapeutic indices and regular side effects. The primary goal of the present study is to evaluate imipenem usage in Bone Marrow Transplantation (BMT) wards.

Methods: The study was a prospective DUE study, carried out in three BMT wards in Dr. Shariati hospital, Hematology- Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences. The study was performed from April 2008 to October 2008. NCCN Clinical Practice Guidelines in Oncology and AHFS recommended protocols were used for evaluation. For a statistical analysis, SPSS (version 16.0) was used.

Results: A total of 64 patients were evaluated during the study. In all patients, imipenem was started empirically. In thirty five (54.7%) patients, the antibiotic seemed to be effective. Twenty- two (35.9%) patients needed dosage adjustments due to low weight or renal failure, but no action in this regard was taken. In 51.6% of patients, the antibiotic therapy duration was not appropriate. Thirty seven (57.8%) patients experienced nausea.

Conclusion: Imipenem in febrile neutropenic patients is administered empirically. Imipenem induced nausea was observed in 57.8% of patients. This result may be due to rapid infusion of imipenem in the wards. The result of this study indicates the need for further education on dosage adjustment based on renal function and patients’ weight.

Improper duration of the treatment could result in resistance and thus should be noted.