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Research suggests a pharmacist-led approach can cut unneeded antibiotic use—especially at small community hospitals.

The study, which included four community hospitals in North Carolina, demonstrated an approach that could expand to the nation’s wider network of small hospitals, where more than half of the US population receives care.

“This is a matter of major consequence, because up to 50% of antibiotic use in our study was inappropriate, meaning there was a better choice or the prescription was simply unnecessary,” says Deverick Anderson, director of the Duke Center for Antimicrobial Stewardship and Infection Prevention and lead author of the paper in JAMA Network Open.

“We have to develop systems that are scalable and effective in helping reduce the improper or needless use of antibiotics at every level,” Anderson says, noting that overuse of these critical drugs has led to the spread of deadly superbugs that are resistant to previously effective treatments.

Two strategies

Anderson and colleagues partnered with the community hospitals in North Carolina to explore how best to perform active, CDC-recommended stewardship interventions using existing hospital resources.

The researchers tested two strategies using hospital pharmacists as designated stewards. One strategy enlisted pharmacists as the gatekeepers for antibiotic use, giving pre-approval to doctors before the doctors could prescribe the drugs to patients.

Researchers quickly determined this pre-approval aspect was too difficult, because doctors wanted the flexibility and autonomy to manage their patients. Instead, they adopted a modified approach, in which doctors could prescribe the first dose of antibiotic, which a pharmacist then reviewed.

The second tested strategy involved a post-prescription audit, where pharmacists reviewed the effectiveness of the antibiotic to determine whether a patient should continue taking it or receive something different after taking it for three days.

All four hospitals participated in both interventions for six months. Nearly 2,700 patients participated.

Audits and antibiotic use

The findings show that pharmacists at the four participating hospitals performed 1,456 modified prescription approvals and 1,236 post-prescription audits. Study antimicrobials were determined to be inappropriate two times as often under the post-prescription audit strategy compared to the modified pre-approval strategy.

Overall antibiotic utilization decreased under the audit system compared to historical controls, but the modified prescription authorization intervention did not reduce the use of antibiotics.

“Even modest decreases in antimicrobial utilization are valuable, particularly when potentially achievable in the more than 3,000 community hospitals in the US,” Anderson says. “This study suggests there are approaches that can work, even in hospitals where resources might be limited.”

The National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, supported the work.

Source: Duke University