Intervention to Discontinue Parenteral Antimicrobial Therapy in Hospitalized Patients with Urinary Tract Infection, Skin and Soft Tissue Infection, or No Evident Infection

Abstract

For patients of compliant physicians hospitalized with urinary tract infection, skin and soft tissue infection, or no evident infection, cessation of parenteral antimicrobials did not significantly shorten LOS, due to brief LOS of patients of control physicians. Patients of noncompliant physicians experienced more adverse events and prolonged LOS. The appropriateness of routine continuous use of parenteral antimicrobials in medically stable inpatients is questioned.

A Prospective, Randomized Trial to Assess the Cost Impact of Pharmacist-Initiated Interventions

“…The fact that we did not find a significant reduction in the length of hospital stay is consistent with the findings of other prospective, randomized intervention studies. 2,19,20 Finally, the savings from just those interventions that were aimed at reducing drug costs (eg, 21% of all interventions) are still substantial. The drug cost savings from these types of interventions are estimated to be nearly $400 000 per year at our hospital.…”

Trends in hospital antibiotic prescribing after introduction of an antibiotic policy

“…Ciprofloxacin became widely used despite its use being restricted. There has been discussion about increasing the use of oral antibiotics in hospital to save on costs and reduce the hazards to patients (Ehrenkranz et al, 1993). Table II shows, perhaps surprisingly, that with the exception of penicillin prescriptions, all antibiotics were mainly prescribed as oral preparations where these were available.…”

Controlled Trials to Improve Antibiotic Utilization: A Systematic Review of Experience, 1984–2004

“…One pharmacist-mediated intervention and two nurse reviewer-mediated interventions assessed the impact of automatic consultations on antibiotic use and length of hospitalization. [57][58][59] The randomized trial of pharmacist consultation showed a reduction of antibiotic costs in the intervention versus the control group ($19.82 vs $35.84/patient, p=0.03). 57 However, hospital stay was not affected, and the total cost of the intervention exceeded antibiotic savings.…”

“…A research group conducted two studies of the nurse reviewer consultations. One of these studies addressed the discontinuation of intravenous antibiotics in patients with hospitalacquired pneumonia, 58 and the other focused on other types of infections, including infections of the urinary tract and soft tissues. 59 In both cases, compliant physicians in the intervention group prescribed shorter courses of parenteral antibiotics.…”