| Description |
The objective of this project was to develop computerized methods to monitor and recommend dosage changes of patients treated with excessive dosages of imipenem/cilastatin (imipenem) and to determine the incidence if imipenem-associated seizers. A prospective, observational, and interventional study design was chosen for this project. The study population consisted of all patients admitted to LDS Hospital and treated with imipenem from May 1, 1987 through October 1, 1992. LDS Hospital, Salt Lake City, Utah, is a 520-bed tertiary care center associated with the University of Utah School of Medicine, Salt Lake City, Utah. Computerized algorithms (knows as frames) were developed, on the hospital information system that exists at LDS Hospital, to identify and monitor patients receiving imipenem. These frames screened the computer-stored medical records of all inpatient admission for prescription orders for imipenem. Computer-based frames estimated the renal function of each imipenem-treated patient and when does were determined to be excessive an imipenem dosing frame alerted the investigator. Additional computer-generated surveillance alerts identified patients who were receiving anticonvulsants concomitantly with imipenem or whose therapy reflected dosage changes in the previous 24 hours. Each day a list of all imipenem-treated patients with alerts was reviewed by a clinical pharmacist and prescribing physicians were contacted if the computer-generated suggestions were clinically relevant. From May1, 1987 to October 1, 1992 all hospital admissions (135,890) at LDS Hospital were prospectively monitored. During the study period 2,615 patients were treated with imipenem. The following risk factors for imipenem-associated seizures were observed in the imipenem-treated population: abnormal renal function (70%), stroke (5%), head trauma (1%), and seizure disorder (0.5%). The observational and interventional methods employed in this study resulted in 82.3% of the patients receiving imipenem doses appropriate for their corresponding renal function. During the study period six seizures (0.23%) were detected in the imipenem-treated patients. All six patients were receiving imipenem doses that were excessive for their renal function. In conclusion, the 0.23% seizure rate that was observed in this investigation in lower than the 1-2% rate reported in the literature despite the fact that 76.5% of the patients who received imipenem had risk factors for seizures. Appropriate dosing of imipenem result in a low rate of associated seizures. Computer-assisted monitoring of imipenem doses, in relation to renal function, resulted in a reduced risk of seizures in this study. |
