Outpatient antibiotic stewardship: Interventions and opportunities

Dobson, Erica; Klepser, Michael E.; Pogue, Jason M.; Labreche, Matthew J.; Adams, Alex J.; Gauthier, Timothy P.; Turner, R. Brigg; Su, Christy P.; Jacobs, David M.; Suda, Katie J.

doi:10.1016/j.japh.2017.03.014

Cited by 64 publications

(53 citation statements)

References 75 publications

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“…It is, therefore, encouraging to see that 12 of the 13 included studies with an education component included aspects beyond education. Furthermore, three of those studies also included a patient education component, which may be an essential objective because pressure from patients and family may contribute to prescribing decisions in LTCFs …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, three of those studies also included a patient education component, which may be an essential objective because pressure from patients and family may contribute to prescribing decisions in LTCFs. 9,41 The main challenges of conducting meta-analysis on the impact of antimicrobial stewardship strategies in LTCFs are the few published studies and the lack of diversity of study designs, interventions, and outcomes. A review found that less than 0.3% of published citations on antibiotic use and resistance focused on LTCFs, indicating a lack of research and development in this area compared with other healthcare settings (eg, primary care).…”

Section: Discussionmentioning

confidence: 99%

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Antimicrobial Stewardship Programs in Long‐Term Care Settings: A Meta‐Analysis and Systematic Review

Langford

Daneman

et al. 2018

J American Geriatrics Society

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BACKGROUND Antimicrobial stewardship programs have been established in hospitals, but less studied in long‐term care facilities (LTCFs), a setting with unique challenges related to patient populations and available resources. This systematic review sought to provide a comprehensive assessment of antimicrobial stewardship interventions implemented in LTCFs, using meta‐analysis to examine their impact on overall antimicrobial use. METHODS Electronic searches of MEDLINE, Embase, and CINAHL (1990 to July 2018) identified any antimicrobial stewardship interventions in LTCFs, with no restriction on patient population, study design, or outcomes. Intervention components were categorized using the Cochrane Effective Practice and Organization of Care taxonomy on implementation strategies. Random‐effects meta‐analysis used ratio of means to facilitate pooling of different metrics of antimicrobial use. RESULTS Eighteen studies (one randomized controlled trial [RCT], four cluster RCTs, four controlled pre/post studies, and nine uncontrolled pre/post studies) met inclusion, using 13 different antimicrobial stewardship intervention strategies; 15 studies used multifaceted (maximum, seven; median, four) interventions. The three most commonly implemented strategies were educational materials, educational meetings, and guideline implementation. Intervention labor intensity and resource requirements varied considerably among interventions. Meta‐analysis of 11 studies demonstrated that antimicrobial stewardship strategies were associated with a 14% reduction in overall antimicrobial use (95% confidence interval = −8% to −20%; P < .0001), with similar results by study design but high heterogeneity (I2 = 86%) for the uncontrolled pre/post study subgroup and no heterogeneity (I2 = 0%) for the cluster RCT and controlled pre/post study subgroups. Funnel plot analysis suggested publication bias, with a lack of publication of smaller studies showing increased antibiotic use. CONCLUSION Antimicrobial stewardship strategies implemented in long‐term care vary considerably in design and resource intensity, but collectively suggest potential to reduce antimicrobial use in this challenging setting. J Am Geriatr Soc 67:392–399, 2019.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antimicrobial Stewardship Programs in Long‐Term Care Settings: A Meta‐Analysis and Systematic Review

Langford

Daneman

et al. 2018

J American Geriatrics Society

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“…A 2019 systematic review and meta-analysis demonstrated that GP-pharmacist collaborative AMS strategies are effective in reducing antibiotic prescribing (up to 12%) and improving guideline-adherent prescribing (up to 16%) by GPs [17]. Nevertheless, GP-CP collaborative AMS implementation models to optimise antimicrobial use in community are less explored worldwide [8,18].…”

Section: Introductionmentioning

confidence: 99%

Knowledge, Perceptions and Practices of Community Pharmacists Towards Antimicrobial Stewardship: A Systematic Scoping Review

et al. 2019

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The scope of antimicrobial stewardship (AMS) surveys on community pharmacists (CPs) is uncertain. This study examines the breadth and quality of AMS survey tools measuring the stewardship knowledge, perceptions and practices (KPP) of CPs and analyse survey outcomes. Following PRISMA-ScR checklist and Arksey and O'Malley's methodological framework seven medical databases were searched. Two reviewers independently screened the literatures, assessed quality of surveys and KPP outcomes were analysed and described. Ten surveys were identified that assessed CPs' AMS perceptions (n = 7) and practices (n = 8) but none that assessed AMS knowledge. Three survey tools had been formally validated. Most CPs perceived that AMS improved patient care (median 86.0%, IQR, 83.3-93.5%, n = 6), and reduced inappropriate antibiotic use (84.0%, IQR, 83-85%, n = 2). CPs collaborated with prescribers for infection control (54.7%, IQR 34.8-63.2%, n = 4) and for uncertain antibiotic treatment (77.0%, IQR 55.2-77.8%, n = 5). CPs educated patients (53.0%, IQR, 43.2-67.4%, n = 5) and screened guideline-compliance of antimicrobial prescriptions (47.5%, IQR, 25.2-58.3%, n = 3). Guidelines, training, interactions with prescribers, and reimbursement models were major barriers to CP-led AMS implementation. A limited number of validated survey tools are available to assess AMS perceptions and practices of CPs. AMS survey tools require further development to assess stewardship knowledge, stewardship targets, and implementation by CPs.

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“…Pharmacists have a history of successfully engaging in outpatient antimicrobial stewardship initiatives . Surveys of pharmacists regarding nonprescription oseltamivir demonstrate a sensitivity to the issue of resistance …”

Section: Key Areas Of Concern From Stakeholdersmentioning

confidence: 99%

Pharmacy-based management of influenza: lessons learned from research

Klepser

Adams

2018

International Journal of Pharmacy Practice

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Recently, several jurisdictions have pursued legislative and regulatory changes to allow pharmacy‐based influenza management models in which pharmacists can initiate appropriate antiviral therapy in community pharmacy settings. While studies have been published in Canada, Japan, New Zealand, Norway and the United States, concerns have been expressed over pharmacist training, the accuracy of rapid influenza diagnostic tests, and the potential impact on antimicrobial resistance, among others. Studies have demonstrated that pharmacists provide safe and effective influenza management, with high rates of patient satisfaction, while maintaining or improving antimicrobial stewardship.

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Outpatient antibiotic stewardship: Interventions and opportunities

Cited by 64 publications

References 75 publications

Antimicrobial Stewardship Programs in Long‐Term Care Settings: A Meta‐Analysis and Systematic Review

Antimicrobial Stewardship Programs in Long‐Term Care Settings: A Meta‐Analysis and Systematic Review

Knowledge, Perceptions and Practices of Community Pharmacists Towards Antimicrobial Stewardship: A Systematic Scoping Review

Pharmacy-based management of influenza: lessons learned from research

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