An Evaluation of Selected Indications and Appropriateness of Ampicillin/Sulbactam, an Unrestricted Antimicrobial, at a Single Center.

BACKGROUND: With antimicrobial resistance on the rise and few new agents in development, it is important to exercise prudent judgment when utilizing antimicrobials. The Antimicrobial Stewardship Program (ASP) is responsible for facilitating the appropriate use of antimicrobials at the institution. Restricted antimicrobials and select additional antimicrobials are monitored by the ASP team to determine if the indications chosen by the ordering prescribers correspond to and are appropriate for the patients' infections. The purpose of this study was to review ampicillin/sulbactam, an unrestricted antimicrobial, due to its declining effectiveness against Escherichia coli .

METHODS: A retrospective chart review was conducted with adult inpatients receiving ampicillin/sulbactam. One hundred consecutive orders for ampicillin/sulbactam were reviewed.

RESULTS: The greatest number of orders for ampicillin/sulbactam came from the Emergency Trauma, Medicine, and Surgery services. The indications selected by the ordering providers were: skin and soft tissue infection (33 orders), community-acquired respiratory infection (22 orders), other (14 orders), intra-abdominal infection due to susceptible organism (13 orders), urinary tract infection (nine orders), head/neck infection (five orders), infection due to human or animal bite (three orders), and diabetic foot infection (one order).

CONCLUSIONS: The correct indication was selected in 78% of orders that were reviewed for correctness. Empiric ampicillin/sulbactam was appropriate in 51% of orders, with the majority of inappropriate empiric usage being intra-abdominal and urinary tract infections.