Stewardship rules, drug review tied to better antibiotic prescribing
Implementing a set of rules targeting antimicrobial stewardship (AMS) into a hospital-wide medication review service was associated with a dramatic decline in inappropriate antibiotic prescribing, Belgian researchers reported last week in the Journal of Antimicrobial Chemotherapy.
The interrupted time series (ITS) analysis looked at inappropriate antibiotic prescribing at a tertiary care hospital in Belgium in the year before and 2 years after 41 AMS-related clinical rules were added to the hospital’s Check of Medication Appropriateness (CMA) service. The CMA is a pharmacist-led medication review service that screens electronic medical record data for potentially inappropriate prescriptions (PIPs). For each identified PIP, the pharmacist formulated a recommendation for the prescribing physician. The study aimed to estimate the effect of the CMA on AMS-related residual PIPs.
Pre-implementation, a median proportion of 75% residual PIPs per day was observed at the hospital. After the CMA intervention, the proportion was reduced to 8% per day. Use of the AMS-related clinical rules resulted in an immediate relative reduction of 86.7% in AMS-related residual PIPs. No significant underlying time trends were observed during the study period.
Post-implementation, 2,790 recommendations were provided, of which 81.32% were accepted. The clinical rule “inappropriate dosing of piperacillin-tazobactam” accounted for the highest proportion of recommendations (24.34%).
“Our ITS analysis showed that this approach is effective in supporting clinicians in antimicrobial prescribing, ultimately aiming to optimize clinical outcomes and minimize unintended consequences of antimicrobial use,” the study authors wrote.
Oct 7 J Antimicrob Chemother abstract
Tanzanian study finds high antibiotic use in postnatal women, newborns
Point-prevalence surveys at three hospitals in Tanzania found substantial overuse of antibiotics in postnatal women and newborns, researchers reported late last week in Antimicrobial Resistance and Infection Control.
The surveys were conducted at three public-sector hospitals in Dar es Salaam in 2018 to collect data on antibiotic use and infections in maternity and neonatal wards. Researchers collected data on a total of 376 mothers and 162 newborns across three rounds.
Antibiotic prescribing was high in all three hospitals among women in caesarean section wards, ranging from 90% to 100%. Antibiotic use varied considerably among women in the postnatal vaginal delivery wards, ranging from 1.4% to 63%. Antibiotic use in newborns ranged from 89% to 100%. The most common reasons for antibiotic prescriptions at all three hospitals were medical or postoperative surgical prophylaxis (prevention).
The study authors said that they expected to see high levels of antibiotic use on caesarean section wards, given that the procedure carries a higher risk of infection and surgical prophylaxis is recommended, but they point out that those antibiotics should be given pre- rather than postoperatively. In addition, they note that, of the 76 newborns treated with antibiotics, 57% had no clear indication for antibiotic use.
“Irrational overuse of antibiotics is likely to ultimately lead to severe illness and death in mothers and newborns as a result of increasing levels of antibiotic resistance in low-income countries,” they wrote. “Better infection control policies, local and national guidelines, and antimicrobial stewardship programs need to be implemented to avoid unnecessary prescription of the antibiotics and promotion of antibiotic resistance.”
Oct 9 Antimicrob Resist Infect Control study