In the era of multidrug resistance, it is critical to utilize antibiotics in an appropriate manner and to identify new treatments or revisit the use of 'forgotten' drugs. Because urinary tract infections (UTIs) are common, particularly in an increasing elderly population, the 'forgotten' drug, methenamine, may become important as a preventive therapy for recurrent UTIs. Methenamine, a urinary antibacterial agent, can be used as methenamine hippurate or methenamine mandelate preparations and is United States Food and Drug Administration-approved. This article discusses the place of preventive therapy for recurrent UTIs, chemistry, mechanism of action, pharmacology, clinical uses, dosage, adverse reactions and safety, and drug interactions of methenamine. Because of its unique antiseptic property, the authors suggest that methenamine should be considered when more commonly used antibiotics fail to suppress recurrent UTIs.
Background
An antimicrobial stewardship program (ASP), aiming to optimize antimicrobial usage, was implemented at a Veterans Affairs Health Care System (VA HCS).
Objective
The main objective of this study was to compare antimicrobial usage before and after implementation of an ASP and to assess ASP interventions.
Method
This retrospective study was conducted at the Fargo VA HCS. A total of 1,017 inpatient charts were reviewed for 2 distinct time periods, February through September 2008 (pre ASP) and February through September 2010 (post ASP). The data that were collected and analyzed included the number of hospitalized patients prescribed antimicrobials, antimicrobial therapy duration, duration of hospital stay, and inpatient antimicrobial costs. Subgroup analyses were performed on the top 5 antimicrobials and the top 6 indications. The number, types of, and overall acceptance rate of ASP interventions were also assessed.
Results
When the pre- to post-ASP periods were compared, the percentage of patients on antimicrobial therapy decreased from 36.8% to 25% (P < .001), the median duration of antimicrobial therapy significantly decreased (P = .02), and the defined daily dose (DDD) per 1,000 patient bed days was reduced for piperacillin/tazobactam, vancomycin, and ciprofloxacin. In addition, the total inpatient antimicrobial costs decreased by $48,044 (25%). The overall ASP intervention acceptance rate was 81.6% (315 out of 386 total interventions).
Conclusion
The results of this study show that ASP implementation has been highly accepted by providers and has been associated with a reduction in the number of patients prescribed antimicrobials, median duration of antimicrobial therapy, and antimicrobial inpatient costs.
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