Trends in antibiotic prescribing in Grampian have been monitored prospectively for 11 years from 1986 using computerized ward stock lists and laboratory data relating to all in-patient and out-patient treatments in all Grampian hospitals. The main outcome measures were the number of antibiotics available for routine and restricted use, annual expenditure and defined daily doses (DDDs) of high expenditure antimicrobial agents. An antibiotic committee introduced a policy and formulary in the third year of the study which has had only limited success in controlling prescribing. This report updates the audit from 1992/3 to 1996/7. During this period 22 new antibiotics were considered for inclusion in the hospital formulary. Seventeen, including seven antiretroviral agents, were incorporated, all for restricted use only. Despite this, expenditure on antibiotics has more than trebled since 1986/7 and increased 50% since 1992/3, two-thirds of the latter increase being due to the use of new drugs, namely anti-HIV drugs, lipid amphotericin derivatives and teicoplanin. Big increases in the use of co-amoxiclav, acyclovir, ciprofloxacin and cefotaxime account for the remainder of the increased expenditure. There was an overall increase of 16.9% in DDDs between 1992/3 and 96/7 to 424.0 DDDs/1000 patient days (393.4 DDDs for antibacterials). These findings highlight the current difficulty in controlling prescribing budgets, the increasing use of antibiotics and the consequent increase of antimicrobial-resistant microorganisms.

This study demonstrates a significant overuse of antibiotics, especially intravenous forms, despite a paucity of positive sepsis parameters and chest X-ray findings in these patients The duration of treatment could be shortened and an early switch policy introduced if culture results and sepsis profiles were taken into consideration, as there was a large number of unproven infections. Suggestions are made about how these improvements in prescribing could be made within the current administrative set-up of AMAUs.

Trends in antibiotic prescribing in Grampian were monitored prospectively for seven years from 1986 using computerised ward stock lists and laboratory data relating to all in-patient and out-patient treatments in all Grampian hospitals serving a population of 500,000. The main outcome measures were the number of antibiotics available for routine and restricted uses, annual expenditure and defined daily doses (DDDs) of high expenditure antimicrobial agents. An antibiotic committee introduced a policy and formulary in the third year of the study which had only limited success in controlling prescribing. During the period of the study 30 new antibiotics were considered for inclusion in the hospital formulary, but only seven were incorporated, and all for restricted use only. Despite this, expenditure on antibiotics has more than doubled since 1986, two thirds of the increase being due to the use of new drugs. There was also an increased use of older antibiotics (DDDs increased by 33%), often for no clear reasons, and an overall increase of 46% in DDDs. Antibiotics have increased from 11.9-18.7% as a proportion of the drug budget. These findings highlight the current difficulty in controlling prescribing budgets, the increasing use of antibiotics and the consequent spread of resistance.

The kinetics of the decomposition of dextrose have been investigated over a temperature range of 106" to 127". The reaction is shown to exhibit an induction period with respect to 5-hydroxymethylfurfural production which is due to the formation of an intermediate compound. A reaction mechanism is proposed which appears consistent with the experimental measurements. Rate constants are calculated for the various reaction steps and the activation energies associated with these steps are reported.Dextrose decomposes under autoclaving conditions, one of the main decomposition products being 5-hydroxymethylfurfural (5-HMF).The kinetics of this decomposition have been extensively studied usually by measuring the rate of dextrose depletion or the rate of 5-HMF production. Most investigators have equated these rates. The rate of the decomposition reaction is relatively small and previous workers have accelerated the decomposition by working in solutions of fairly high acid concentration. These measurements have, in general, shown that the reaction is first order in dextrose concentration and that it is catalysed by hydrogen ion. Kinetic treatment of the decomposition has been made on a reaction mechanism represented by Dextrose -+ 5-HMF -+ Products The products of the second step in the reaction have been assumed to be formic and laevulinic acids.It has been shown (Wolfram, Schuetz & Cavalieri, 1948) on the basis of spectroscopic evidence that there is an intermediate compound produced during the formation of 5-HMF from dextrose. These observations would appear to indicate that, under conditions of autoclaving, fairly neutral solutions of dextrose decompose according to a mechanism Dextrose -+ Intermediate -+ 5-HMF -+ ProductsThe purpose of the present investigation was to study the effect of changes in dextrose concentration, temperature and pH on the kinetics of dextrose decomposition actually encountered during autoclaving and to determine if the mechanism is adequately represented by either of the above schemes. The interest in such a reaction lies in the concentration of the various decomposition products arising as a function of time rather than the concentration of dextrose decomposed.t Present address, Western General Hospital, Edinburgh, U.K.