Antibacterial treatment strategies in hospitalized patients: what role for pharmacoeconomics?

A prospective cluster trial to increase antibiotic prescription quality in seven non-ICU wards

Aim

To evaluate general shortcomings and faculty-specific pitfalls as well as to improve antibiotic prescription quality (ABQ) in non-ICU wards, we performed a prospective cluster trial.

Methods

An infectious-disease (ID) consulting service performed a prospective investigation consisting of three 12-week phases with point prevalence evaluation conducted once per week (=36 evaluations in total) at seven non-ICU wards, followed by assessment of sustainability (weeks 37-48). Baseline evaluation (phase 1) defined multifaceted interventions by identifying the main shortcomings. Then, to distinguish intervention from time effects, the interventions were performed in four wards, and the 3 remaining wards served as controls; after assessing effects (phase 2), the same interventions were performed in the remaining wards to test the generalizability of the interventions (phase 3). The prolonged responses after all interventions were then analyzed in phase 4. ABQ was evaluated by at least two ID specialists who assessed the indication for therapy, the adherence to the hospital guidelines for empirical therapy, and the overall antibiotic prescription quality.

Results

In phase 1, 406 of 659 (62%) patients cases were adequately treated with antibiotics; the main reason for inappropriate prescription was the lack of an indication (107/253; 42%). The antibiotic prescription quality (ABQ) significantly increased, reaching 86% in all wards after the focused interventions (502/584; nDf=3, ddf=1,697, F=6.9, p=0.0001). In phase 2 the effect was only seen in wards that already participated in interventions (248/347; 71%). No improvement was seen in wards that received interventions only after phase 2 (189/295; 64%). A given indication significantly increased from about 80% to more than 90% (p<.0001). No carryover effects were observed.

Discussion

ABQ can be improved significantly by intervention bundles with apparent sustainable effects.

Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases

Introduction

In the time of increasing resistance and paucity of new drug development there is a growing need for strategies to enhance rational use of antibiotics in German and Austrian hospitals. An evidence-based guideline on recommendations for implementation of antibiotic stewardship (ABS) programmes was developed by the German Society for Infectious Diseases in association with the following societies, associations and institutions: German Society of Hospital Pharmacists, German Society for Hygiene and Microbiology, Paul Ehrlich Society for Chemotherapy, The Austrian Association of Hospital Pharmacists, Austrian Society for Infectious Diseases and Tropical Medicine, Austrian Society for Antimicrobial Chemotherapy, Robert Koch Institute.

Materials and methods

A structured literature research was performed in the databases EMBASE, BIOSIS, MEDLINE and The Cochrane Library from January 2006 to November 2010 with an update to April 2012 (MEDLINE and The Cochrane Library). The grading of recommendations in relation to their evidence is according to the AWMF Guidance Manual and Rules for Guideline Development.

Conclusion

The guideline provides the grounds for rational use of antibiotics in hospital to counteract antimicrobial resistance and to improve the quality of care of patients with infections by maximising clinical outcomes while minimising toxicity. Requirements for a successful implementation of ABS programmes as well as core and supplemental ABS strategies are outlined. The German version of the guideline was published by the German Association of the Scientific Medical Societies (AWMF) in December 2013.

Perfil da utilização de antimicrobianos em um hospital privado

Os antimicrobianos são um dos grupos de medicamentos mais prescritos nos hospitais e que causam uma grande preocupação quanto à adequação do seu uso. Descreveu-se o perfil dos antimicrobianos utilizados num hospital privado do interior do Rio Grande do Sul, analisando a quantidade consumida de cada antimicrobiano. Foram analisadas todas as prescrições de pacientes que utilizaram antimicrobianos enquanto internados no período de março a junho de 2006. O consumo dos antimicrobianos foi expresso em dose diária definida (DDD) por 100 leitos-dia. As análises de utilização de antimicrobianos foram feitas em geral e estratificadas por grupos de idade e por clínicas médicas. Durante o período em estudo, a prevalência do uso de antimicrobianos foi de 52,4% (IC95% 49,2-55,7). As cefalosporinas foram as mais utilizadas (43,4%), seguidas das penicilinas (16,3%), fluorquinolonas (13,0%) e aminoglicosídeos (9,7%). O alto consumo de antimicrobianos durante o período em estudo é resultado da ausência de uma política de controle dos medicamentos prescritos no hospital e da falta de protocolos de uso de antimicrobianos. Para que haja um controle do consumo de antimicrobianos, os hospitais devem assumir uma política de vigilância sobre as prescrições deste grupo de medicamentos.