Antibiotic optimization. An evaluation of patient safety and economic outcomes

Abstract

This is the first randomized study to evaluate whether antibiotic choices can be influenced in a cost-effective fashion without sacrificing patient safety. We demonstrate that 50% of patients initially treated with expensive parenteral antibiotics can have their regimens refined after 3 days of therapy and that these modifications result in good clinical outcomes with a substantial reduction in antibiotic expense.

Reliability of assessment of adherence to an antimicrobial treatment guideline

“…[1][2][3] Programmes to optimize antimicrobial use have reduced the cost and volume of therapy while optimizing care. [4][5][6] Adherence to hospital antibiotic guidelines is a commonly used primary outcome measure in studies of antimicrobial treatment patterns. In some of these studies, an infectious disease specialist reviewed medical charts to assess adherence to a guideline.…”

“…[7][8][9][10][11][12] In other studies, junior clinical or hospital pharmacists, internists or residents, and clinical microbiologists reviewed prescribing appropriateness or adherence. [4][5][6][13][14][15][16][17][18][19][20] However, low to moderate agreement was found by some authors in assessments. 10,17 Satisfactory levels of agreement were only found between professionals of the same professional background, such as between hospital pharmacists, using the medication appropriateness index, an assessment tool for appropriate prescribing.…”

Optimización del tratamiento antibiótico mediante la participación de expertos en antibióticos

“…Una variedad de estos programas consiste en establecer una lista de antibióticos restringidos cuya administración requiere una autorización previa (3,6,7,10,11). Uno de los problemas de este enfoque es que el clínico prescriptor puede contemplarlo como una mera traba burocrática, pudiendo existir, además, el riesgo de atribuir a una determinada restricción antibiótica una potencial mala evolución de un caso particular (2,12). Las actuaciones no impositivas para mejorar el uso antibiótico presentan, sin embargo, un perfil más adecuado para su puesta en práctica (2,3).…”

“…Este tipo de actuación es una de las razones de la existencia de las unidades de infectología en los hospitales generales (12)(13)(14)16,17). Nuestra intervención no se asoció a ningún dato que haga sospechar peor evolución de los pacientes, ya que ni la mortalidad ni la incidencia de de infecciones por bacterias resistentes durante el periodo de estudio aumentaron significativamente.…”

Panresistant Superbugs: Are We at the Edge of a ‘Microbial Holocaust’

“…Prescription trend factors include aggressive exposure of multiple antimicrobials to patients harbouring multiresistant microorganisms. Rising empiricism in antimicrobial therapy overshadows susceptibility guided therapy, facilitating development of resistance due to selection pressure [9,10]. Panresistant microorganisms can spread resistance-conferring mobile genetic elements to susceptible microorganisms and commensal flora, contributing to the development of a reservoir of antimicrobial resistance in human body.…”