https://www.cidrap.umn.edu/news-per...-stewardship-rules-scarce-antibiotics-57-time
Prescribers followed stewardship rules for scarce antibiotics 57% of the time
Filed Under:
Drug Supply Chains;
Antimicrobial Stewardship
Dec 05, 2022
During shortages of five antibiotics at a Kansas City children's hospital, prescribers adhered to restriction protocols 57% of the time, according to a study published last week in the American Journal of Health-System Pharmacy.
A team led by Children's Mercy Kansas City researchers reviewed the medical records of 266 children hospitalized during shortages of five antimicrobials from 2015 to 2020 to determine adherence to restriction criteria. Shortages of the drugs, which included ampicillin/sulbactam, cefepime, meropenem, piperacillin/tazobactam, and metronidazole, were communicated to clinicians.
Among the 266 patients, antimicrobial use followed restriction criteria for 57%. The highest adherence rates were for meropenem, ampicillin/sulbactam, and piperacillin/tazobactam. Median days of therapy (DOT) were shorter in the nonadherent than in the adherent group (2 vs 4 days, respectively), and fewer average doses were given (6 vs 16, respectively).
Prescribers were most often nonadherent when using antimicrobials to rule out sepsis, prevent surgical infections, and treat urinary tract infections. The most nonadherent departments were nephrology, gastroenterology/hepatology, and critical care. The addition of the "limited availability" phrase next to a medication name in the electronic medical record (EMR) was associated with increased adherence (99% vs 94%).
DOT of all shortage antibiotics, except cefepime, fell during restriction periods, but after shortages were resolved, DOT exceeded the baseline for all antibiotics except meropenem and metronidazole, which returned to baseline. Use of one to three recommended alternative antimicrobials for each drug rose significantly during restrictions.
The researchers noted that antimicrobial shortages can complicate patient care because use of nonpreferred drugs can be less effective or more toxic. "Frequently used alternative agents have a broader spectrum of activity, which can promote the development of antimicrobial resistance in the patient and community," they wrote. "Additional factors such as patient allergies, age, and comorbid conditions further limit the selection of alternative antimicrobials."
The authors said that while overall use of shortage antibiotics fell significantly during the study period, adherence to stewardship protocols was relatively low. "Overall, opportunity exists for the standardization of antimicrobial shortage management."
Prescribers followed stewardship rules for scarce antibiotics 57% of the time
Filed Under:
Drug Supply Chains;
Antimicrobial Stewardship
Dec 05, 2022
During shortages of five antibiotics at a Kansas City children's hospital, prescribers adhered to restriction protocols 57% of the time, according to a study published last week in the American Journal of Health-System Pharmacy.
A team led by Children's Mercy Kansas City researchers reviewed the medical records of 266 children hospitalized during shortages of five antimicrobials from 2015 to 2020 to determine adherence to restriction criteria. Shortages of the drugs, which included ampicillin/sulbactam, cefepime, meropenem, piperacillin/tazobactam, and metronidazole, were communicated to clinicians.
Among the 266 patients, antimicrobial use followed restriction criteria for 57%. The highest adherence rates were for meropenem, ampicillin/sulbactam, and piperacillin/tazobactam. Median days of therapy (DOT) were shorter in the nonadherent than in the adherent group (2 vs 4 days, respectively), and fewer average doses were given (6 vs 16, respectively).
Prescribers were most often nonadherent when using antimicrobials to rule out sepsis, prevent surgical infections, and treat urinary tract infections. The most nonadherent departments were nephrology, gastroenterology/hepatology, and critical care. The addition of the "limited availability" phrase next to a medication name in the electronic medical record (EMR) was associated with increased adherence (99% vs 94%).
DOT of all shortage antibiotics, except cefepime, fell during restriction periods, but after shortages were resolved, DOT exceeded the baseline for all antibiotics except meropenem and metronidazole, which returned to baseline. Use of one to three recommended alternative antimicrobials for each drug rose significantly during restrictions.
The researchers noted that antimicrobial shortages can complicate patient care because use of nonpreferred drugs can be less effective or more toxic. "Frequently used alternative agents have a broader spectrum of activity, which can promote the development of antimicrobial resistance in the patient and community," they wrote. "Additional factors such as patient allergies, age, and comorbid conditions further limit the selection of alternative antimicrobials."
The authors said that while overall use of shortage antibiotics fell significantly during the study period, adherence to stewardship protocols was relatively low. "Overall, opportunity exists for the standardization of antimicrobial shortage management."