Frequently Used Medications in the Hospital Setting
Antibiotics: The Most Commonly Prescribed Class
Beta-lactam antibiotics are the most commonly used antibiotic class in hospitals worldwide, accounting for 69% of antibiotics consumed in critical care settings. 1
Most Frequently Administered Antibiotics
The four most common antibiotics used across all hospital settings are:
- Vancomycin (parenteral) - administered in 14.4% of patients receiving antimicrobial therapy, primarily for suspected methicillin-resistant Staphylococcus aureus (MRSA) coverage 2
- Ceftriaxone - used in 10.8% of patients receiving antimicrobials 2
- Piperacillin-tazobactam - administered in 10.3% of patients receiving antimicrobials 2
- Levofloxacin - given to 9.1% of patients receiving antimicrobials 2
Critical Context About Antibiotic Use
Approximately 50% of patients admitted to hospitals receive at least one antimicrobial drug during their stay, with 77.5% of these drugs used to treat active infections. 2 The most commonly treated infection sites are lower respiratory tract, urinary tract, and skin/soft tissue infections 2.
Important Caveat on Broad-Spectrum Use
Despite broad-spectrum antibiotics being administered to 65-67% of patients with suspected sepsis, resistant organisms are isolated in only 7-10% of cases, meaning 90% of broad-spectrum therapy is unnecessarily broad in retrospect. 3 This represents a critical area where antibiotic stewardship can improve outcomes, as both inadequate AND unnecessarily broad empiric antibiotics are associated with higher mortality 4.
Insulin: The Dominant Diabetes Medication
Insulin is the preferred and most frequently used medication for managing hyperglycemia in hospitalized patients, used in the vast majority of diabetic patients during admission. 1
Insulin Regimen Patterns
- Basal-bolus insulin regimens are the standard of care for non-critically ill patients with good nutritional intake 1
- Continuous intravenous insulin infusion is the most effective method in critical care settings 1
- Sliding-scale insulin alone (correction doses only) is commonly used but generally discouraged except in patients with diet-controlled diabetes or mild stress hyperglycemia 1, 5
Non-Insulin Diabetes Medications
While oral antidiabetic agents are used in hospitals, their use is limited by specific contraindications:
- Metformin - frequently used but must be avoided in patients at risk for lactic acidosis (sepsis, hypoxia, renal impairment with eGFR <30 mL/min) 1
- Sulfonylureas - commonly used but professional societies recommend against them due to sustained hypoglycemia risk 1
- DPP-4 inhibitors - well-tolerated with low hypoglycemia risk in patients with mild-to-moderate hyperglycemia 1
- SGLT2 inhibitors - NOT recommended for routine inpatient use due to euglycemic ketoacidosis risk 1
Opioid Analgesics
Fentanyl and morphine are among the most frequently used medications for pain management in hospitalized patients, particularly in critical care and perioperative settings. 6
Common Opioid Conversion Practice
Hospitals routinely use equianalgesic conversion tables to transition between different opioid formulations, with 10 mg parenteral morphine serving as the standard reference dose 6.
Antibiotic Use Patterns by Clinical Context
Sepsis and Severe Infections
In patients with suspected community-onset sepsis, empiric broad-spectrum therapy accounts for 50% of all anti-MRSA antibiotic days and 49% of all antipseudomonal β-lactam days in hospitals. 3
Recommended Empiric Regimens for Severe Infections
For critically ill patients with severe pneumonia or septicemia with risk factors (underlying diseases, antibiotic pretreatment, mechanical ventilation):
- Combination therapy with an anti-pseudomonal beta-lactam PLUS a fluoroquinolone or aminoglycoside is recommended 7
- Appropriate beta-lactams include cefepime (4th generation cephalosporin), carbapenems (imipenem, meropenem), or piperacillin-tazobactam 7
Timing Considerations
Antibiotic administration within 3 hours of emergency department arrival is associated with significantly improved survival (adjusted OR 0.54 for mortality), greater reversal of organ failure, and shorter hospital length of stay in patients with severe sepsis and septic shock. 8
Key Prescribing Principles
Beta-Lactam Optimization in Critical Care
For critically ill patients receiving beta-lactams, continuous or prolonged infusion is strongly recommended over intermittent bolus dosing to maximize bacteriological and clinical responses. 1 Therapeutic drug monitoring should be used to achieve free plasma concentrations between 4-8 times the minimum inhibitory concentration for 100% of the dosing interval 1.
Common Pitfall to Avoid
The most significant prescribing error is continuing unnecessarily broad-spectrum antibiotics beyond the initial empiric period without de-escalation based on culture results and clinical response. 4, 3 This practice is associated with increased mortality and contributes to antimicrobial resistance without improving outcomes 4.