ADD It Up: An Evaluation of Antibiotic Duration at Hospital Discharge at a Community Hospital

Abstract

Purpose According to the CDC, patients admitted to the hospital are commonly discharged on antibiotic therapy with prolonged courses of therapy, which contributes to excessive antibiotic exposure and adverse events. The purpose of this study was to evaluate total antibiotic duration of therapy at hospital discharge at Indiana University (IU) Health Arnett, White Memorial, and Frankfort Hospitals. Methods A multicenter, retrospective electronic health record review was conducted from January 1, 2019, to June 30, 2019. Patients were included if they were at least 18 years of age, began antibiotic therapy while admitted, and continued antibiotic therapy at hospital discharge for one of the following indications: skin/soft tissue infection (SSTI), urinary tract infection (UTI), community-acquired pneumonia (CAP) or acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The days-of-therapy (DOT) of each inpatient and outpatient antibiotic prescribed were collected to calculate the total DOT, which was utilized to determine the appropriateness of the duration of therapy. Results Of the 547 patients included, 233 patients (42.6%) had CAP, 120 (21.9%) had UTI, 101 (18.5%) had SSTI, and 93 (17%) had AECOPD. The median duration of antibiotic therapy across all indications was 9 days (IQR 7-11). Median duration for CAP was 9 days (IQR 7-10), AECOPD was 7 days (IQR 5-9), UTI was 8 days (IQR 6-10), and SSTI was 12 days (IQR 10-14). Conclusions Excess antimicrobial duration at hospital discharge represents an unmet need of antimicrobial stewardship programs.

Accordance of Registered Drug Packages with Guideline-Recommended Treatment Durations for Community-Acquired Pneumonia—A New Antibiotic Stewardship Target?

“…The inappropriate prescribing of antibiotics upon hospital discharge is well documented, with most patients receiving antibiotics longer than needed or recommended [ 28 ]. Studies evaluating antimicrobial days of treatment on hospital discharge have often found them to be excessive and most pronounced for CAP [ 29 , 30 ].…”

‘’Myth Busting in Infectious Diseases’’: A Comprehensive Review

“…However, alongside their remarkable efficacy, numerous myths and misconceptions have emerged surrounding their use. One example is that the majority of patients are prescribed antibiotics upon hospital discharge for infections, even in cases where there is no clinical necessity; the antibiotic's spectrum of activity is incomplete, or the dosage is inappropriate [2][3][4][5].…”

Impact of a pharmacy department–wide transitions-of-care program on inappropriate oral antibiotic prescribing at hospital discharge

“…1 Recent studies have shown that many hospital-initiated antibiotic courses are completed after hospital discharge. 2,[4][5][6] Furthermore, community-acquired pneumonia (CAP), skin and soft-tissue infection (SSTI), and urinary tract infection (UTI) account for most inappropriate prescriptions. 2,[6][7][8] Therefore, assessing current prescribing practices and optimizing antibiotic discharge prescriptions for these infections could be an effective intervention in antimicrobial stewardship.…”

“…2,[4][5][6] Furthermore, community-acquired pneumonia (CAP), skin and soft-tissue infection (SSTI), and urinary tract infection (UTI) account for most inappropriate prescriptions. 2,[6][7][8] Therefore, assessing current prescribing practices and optimizing antibiotic discharge prescriptions for these infections could be an effective intervention in antimicrobial stewardship. Based on evaluation of our hospital discharge antibiotic prescriptions, we identified a need to optimize oral antibiotic prescriptions for common infections.…”