(P-237) Antimicrobial Use in Patients Diagnosed with Chronic Kidney Disease Admitted in the Internal Medical Wards at Dr George Mukhari Academic Hospital

Background: The study aimed to determine dosage adjustments for all antimicrobials prescribed in CKD patients at internal medicine wards. This information will optimise the management of CKD and minimise medication dosing errors in patients

Objectives: • To identify the most prescribed antimicrobials in patients with chronic kidney disease.
• To determine the indications for the prescribed antimicrobials in patients with chronic kidney disease.
• To assess appropriate dosing of antimicrobials in patients with chronic kidney disease in relation to originator leaflet and Nebraska international guidelines.

Methods: The study was conducted at Dr George Mukhari Academic Hospital, Gauteng Province of South Africa. The internal medicine wards was surveyed.

The prescribed antimicrobials were reviewed to assess whether or not they were adjusted according to the guidelines.

Data collected was captured in a Microsoft ExcelTM spreadsheet. It was then imported to SPSS version 25 and analysed descriptively. Data was analysed with the aid of a statistician. The descriptive statistics analyses such as percentages, the means and standard deviations and frequencies were used. The prevalence of antimicrobial dosages were summarised, using percentage calculations. The description of antimicrobial dosing were grouped as normal, under-dosing or over-dosing.

Results: A total of 41 patient files were reviewed which contained 81 prescribed antimicrobials. The most commonly-prescribed class of antimicrobials was the beta-lactamase inhibitors. The most frequently-prescribed antimicrobial was amoxicillin/clavulanic acid (28.5%) (J01CR02). Of the(21%) antimicrobials which required a dose adjustment, only 7 (41.2%) were adjusted according to the recommended guidelines.

Conclusions: Chronic kidney disease is highly prevalent worldwide and accounts to mortality of hospitalised patients. Due to impaired renal functioning, renal excretion of various drugs will be impaired which includes antimicrobials that are used widely for infectious diseases in CKD and this results in potential harmful effects. The primary aim of this study was to assess dosing of antimicrobials in CKD adult patients and the study found that more than half of prescribed antimicrobials that required dosage adjustments in CKD patients were not adjusted as per guidelines and this could lead to poor outcomes and adverse effects. This may result in the overall loss of kidney function and it is therefore important to have knowledge in the use of antimicrobials in CKD to prevent drug related adverse effects as well as antimicrobial resistance.