Drug utilization review of mupirocin ointment in a Korean university-affiliated hospital

Abstract

Background/AimsIntranasal mupirocin and chlorhexidine bathing are candidate strategies to prevent healthcare-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). In Korea, intranasal mupirocin is not available, and mupirocin ointment, an over-the-counter drug, has been used indiscriminately. Furthermore, because it is covered by health insurance, mupirocin is easy to prescribe within hospitals.MethodsWe performed a mupirocin drug utilization review (DUR) within Hallym University Sacred Heart Hospital. Annual use of mupirocin was investigated between 2003 and 2013, and monthly consumption of mupirocin was assessed during the final 2-year period. The DUR focused on August 2012, the period of highest use of mupirocin. Also, we investigated trends in mupirocin resistance in MRSA between 2011 and 2013.ResultsAnnual consumption of mupirocin increased from 3,529 tubes in 2003 to 6,475 tubes in 2013. During August 2012, 817 tubes were prescribed to 598 patients; of these, 84.9% were prescribed to outpatients, and 77.6% at the dermatology department. The most common indication was prevention of skin infections (84.9%), and the ointment was combined with systemic antibiotics in 62.9% of cases. The average duration of systemic antibiotic administration was about 7.8 days. The rate of low-level mupirocin resistance in MRSA increased from 8.0% to 22.0%, and that of high-level mupirocin resistance increased from about 4.0% to about 7.5%.ConclusionsInappropriate use of mupirocin is prevalent. Considering the increase in resistance and the future application of intranasal mupirocin, prophylactic use of mupirocin in dermatology departments should be reconsidered.

Surgical antimicrobial prophylaxis

“…29 A Korean drug utilisation review found an increase in mupirocin consumption correlated with increases of low-and high-level mupirocin resistance in MRSA infections. 30 Unrestricted use of mupirocin, in particular for wounds and pressure sores, is strongly associated with increased resistance. 29 Fortunately, in Australia, mupirocin is a Schedule 4 prescription-only medicine so both GPs and hospital prescribers have a significant role in reducing its inappropriate use.…”

The Effects after Implementing a Drug Utilization Review System on Contraindicated Drug use: A Systematic Review

“…Korean DUR system notify real-time information to health care providers. 3) When alert appears according to prescribing contraindicated drug, the physician may change or provide a reason to continue for the prescription. For dispensing purposes, a similar alert appears, and the pharmacist should communicate with the prescriber and confirm the prescription.…”

“…Effective implementing DUR system, as supported by various reports, promised to reduce or eliminate serious preventable drug-related adverse events such as contraindicated drug use. 2,3) As contraindicated drug use is life-threatening for some patients, to ensure safety while by DUR systems. 7,8) Others described that current DUR systems fail to "promote appropriate use of medications without having to remove useful but clinically interacting agents from the market" 9) with several studies suspected the efficiency of regulatory actions preventing prescription of contraindicated drugs.…”

“…The DUR system includes a list of medications predefined with DUR criteria including contraindications in pregnant women, drugs with drug-drug interactions, and drugs with age contraindications. 3) It was managed with the Health Insurance Review and Assessment Service (HIRA) database includes nationwide information from hospitals and pharmacies on patient demographics, diagnosis, prescriptions, and healthcare providers, which is linked to the Korean National Health Insurance data that issues reimbursements. 13) Despites of various research supports for the effectiveness of the DUR system in Korea, still, onethird of the users of the DUR system did not agree that the DUR alerts could identify rare adverse drug reactions.…”