Impact of an intervention in the use of sequential antibiotic therapy in a Brazilian university hospital

Abstract

Introduction: Sequential antibiotic therapy (SAT) is safe and economical. However, the unnecessary use of intravenous (IV) administration usually occurs. The objective of this work was to get to know the effectiveness of an intervention to implement the SAT in a teaching hospital in Brazil. Methods: This was a prospective and interventional study, historically controlled, and was conducted in the Hospital de Clínicas, Universidade Federal de Uberlândia, State of Minas Gerais, Brazil, a high complexity teaching hospital having 503 beds. In each of the periods, from 04/04/05 to 07/20/05 (pre-intervention) and from 09/24/07 to 12/20/07 (intervention), 117 patients were evaluated. After the pre-intervention period, guidelines were developed which were implemented during the intervention period along with educational measures and a reminder system added to the patients' prescription. Results: In the pre-intervention and intervention periods, the IV antibiotics were used as treatment for a average time of 14.8 and 11.8 days, respectively. Ceftriaxone was the antibiotic most prescribed in both periods (23.4% and 21.6% respectively). Starting from the first prescription of antibiotics, the average length of hospitalization time was 21.8 and 17.5 days, respectively. The SAT occurred only in 4 and 5 courses of treatment, respectively, and 12.8% and 18.8% of the patients died in the respective periods. Conclusions: Under the presented conditions, the evaluated intervention strategy is ineffective in promoting the exchange of the antibiotic administration from IV to oral treatment (SAT).

Antibiotic use in Brazilian hospitals in the 21st century: a systematic review

“… Small-sized hospitals Medium-sized hospitals Large-sized hospitals Extra-sized hospitals UTI Pediatrics No information Entire hospital 23 Adult ward 26 Entire hospital 24 Cl & Sur ward. ICU 40 ICU 22 ICU tto emp 37 ICU tto dir 37 ICU and Ped ward 25 ICU and Ped ward 30 Ped 31 CM 34 Tetracycline - J01AA - - - - - - - - 1.1 - - Amphenicols - J01BA - - - - - - - - 1.1 - …”

“…This review included 23 articles with different methodological designs. The main objective of seven studies was to analyze antibiotic use 20 , 25 , 26 , 28 , 30 , 39 , 42 , while the others presented this data secondary to a main objective, namely: to investigate the relationship between antibiotic consumption and the incidence of resistant bacteria 27 , 35 , 36 , assess indicators of rational drug use in antibiotic prescriptions 34 , assess the adequacy of antibiotic prescriptions by disease or microorganism 31 , 32 , compare antimicrobial therapy with the microorganisms’ sensitivity profile 22 , 26 , 29 , 37 , and assess the impact of implementing interventions in antibiotic consumption 24 , 33 , 40 , 41 .…”

Benefits of WSES guidelines application for the management of intra-abdominal infections

“…In the recent literature, several studies argue on the necessity of the diffusion of valid guidelines, based on clinical evidence and on the bacterial resistance epidemiology, to rationalize the use of antibiotics [ 2 - 6 ]. Many authors highlight on the importance of the application of validated guidelines in clinical practice and of the surgical prophylaxis protocols, associated with adequate education programs for physicians and surgeons on the “diligent” prescription and administration of antibiotics, in reducing healthcare costs with considerable benefits in terms of cost-effectiveness [ 7 - 11 ].…”

Avaliação de uma intervenção para a descontinuação precoce da terapia antimicrobiana intravenosa

“…Este percentual é muito menor que o encontrado em estudos realizados na América do Sul e no resto do mundo (MCLAUGHLIN et al, 2005;MERTZ et al, 2009;GRILL et al, 2011;ALONSO et al, 2012). A baixa frequência de mudança para terapia oral no HCU já era conhecida (RODRIGUES et al, 2013). O presente estudo não contém evidências suficientes para explicar tal fato.…”

“…O predomínio de infecções do trato urinário, respiratório e intra-abdominais também foi semelhante ao encontrado em outros estudos (VON GUNTEN et al, 2003;MCLAUGHLIN et al, 2005;MERTZ et al, 2009). O resultado significativo do presente estudo contrasta com estudo anterior realizado no mesmo hospital, que demonstrou ineficácia de estratégias como elaboração, apresentação e distribuição de diretriz e lembretes diários aos médicos por meio de etiquetas afixadas nas prescrições (RODRIGUES et al, 2013). A diferença provavelmente se deve ao fato de, que no presente estudo, foram empregados recursos informatizados que disponibilizavam os lembretes no momento da prescrição e, sobretudo, devido ao bloqueio da prescrição, que obrigava o médico a preencher a justificativa para continuidade do uso de antimicrobianos intravenosos.…”