The inappropriate use of antimicrobials is a serious public health problem, generating clinical and economic impact and inducing the spread of resistant microorganisms, causing the loss of antibiotic effectiveness over time. The pharmacist professional is fundamental to change this scenario. Prescription review is an activity of great importance, as all possible nonconformities related to the use of antimicrobials are analyzed, such as indication, dosage, drug interactions, incompatibilities, and correct administration. The present study aims to demonstrate the profile of pharmaceutical interventions in antibiotic therapy of patients hospitalized in the adult Intensive Care Units of a University Hospital.

The study consists of the analysis of pharmaceutical interventions related to antimicrobials in a large university hospital. These interventions are performed by the clinical pharmacy service through the analysis of the medical prescriptions of patients hospitalized in adult Intensive Care Units. Pharmaceutical interventions are classified according to the type of adjustment made, which may be: dose adjustment, dilution, concentration, dosage, infusion time, administration schedule, inclusion request, and withdrawal request. This work is part of a research project approved by the Research Ethics Committee under opinion number 2.650.235.

In total, medical prescriptions from 476 patients were analyzed, of which 411 contained prescribed antibiotics, and among these, 227 required pharmaceutical interventions in antibiotic therapy. The antimicrobials most involved in pharmaceutical interventions were Meropenem, Vancomycin, and Piperacillin + Tazobactam, and the most common interventions were adjustments in administration schedule, infusion time, and also dose and concentration adjustments.

The analysis of medical prescriptions carried out by the clinical pharmacist contributes to the rational use of antimicrobials, since this professional has knowledge of the particularities of each medication as well as its correct use, thus contributing to the execution of the antimicrobial stewardship program.