Cefoxitin use review.

Due to an increase in cefoxitin use at The Mississauga Hospital, a Drug Utilization Review (DUR) was conducted as part of the DUR program. The study was designed to determine the cefoxitin prescribing pattern, assess the appropriateness of use, calculate the cost associated with inappropriate use, and estimate future potential cost savings. Two evaluators (pharmacist and infectious disease specialist), reviewed cefoxitin use retrospectively during a four-month period for 82 patients who received a total of 100 courses of therapy. The appropriateness of cefoxitin use was assessed according to the predefined criteria that were developed and accepted by the hospital pharmacy, infectious disease and medical staff. Cefoxitin was prescribed more frequently by the department of surgery (45%) of the courses studied, while the medical and obstetric and gynecology services were responsible for the remainder of courses (24% and 31% respectively). Overall, 42% of the courses were deemed inappropriate and 11% were questionable, based on the choice of agent (62%) and the duration of treatment and prophylaxis (33%). The observed inappropriate use represented 22% of the amount spent on the total cefoxitin treatment of the 82 study patients. If cefoxitin had been prescribed appropriately, an estimated $11,873 could potentially have been saved annually by the hospital. Based on these results, recommendations for improving the quality and quantity of cefoxitin use were developed. Follow-up concurrent DUR's with pharmacist interventions were initiated and found to be cost-effective.