OBJECTIVES: To assess the impact of dose appropriateness on clinical outcome and evaluation of direct costs involved in antibiotic therapy in renal impairment.

METHODS: A prospective study was conducted on in-patients in the nephrology department, prescribed with antibiotics in a tertiary care hospital. The creatinine clearance (CrCl) was calculated by Cockroft Gault and Jelliffe method. The dose appropriateness was checked by using standard databases and literature from the manufacturer. The direct cost involved in the antibiotic therapy was calculated by accessing IP bills from the finance department.

RESULTS: A total of 163 cases were collected of which 139 was taken for analysis. 80.6% (112) cases were diagnosed with chronic kidney disease (CKD) and 19.4% (27) were diagnosed with acute kidney injury (AKI). The mean age of the population is 54±13 and the mean duration of hospitalization was 6±2 days. Urinary tract infection was the most common infectious complication in the clinical setting. Mono therapy (54.7%) was the most preferred choice, followed by dual therapy (40.3%) and triple therapy (5%). A positive clinical outcome of 79.1% was achieved. Cefoperazone sulbactam was the most widely used antibiotic. A mean difference of 4.55ml/min was obtained when creatinine clearance was calculated by Cockroft Gault and Jelliffe methods in AKI. In CKD, dose appropriateness is a significant factor in achieving a positive clinical outcome. The direct cost involved in the management of CKD was much higher than that of AKI. The management of systemic infections involved maximum costs INR 70,040. 00.

CONCLUSIONS: There is an overestimation of CrCl measured by conventional methods in AKI. Dose appropriateness is a significant factor in achieving a positive clinical outcome. Medicine cost was found to be maximum in comparison to the other costs involved.