Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2019/01/stewardship-resistance-scan-jan-29-2019
Stewardship / Resistance Scan for Jan 29, 2019
Pharmacist interventions; Antibiotics for asthma attack
Filed Under:
Antimicrobial Stewardship
[h=3]Pooled data show pharmacists' input helpful in stewardship programs[/h] A meta-analysis of 15 studies published yesterday in the Journal of Antimicrobial Chemotherapy concluded that antimicrobial stewardship programs (ASPs) involving pharmacists are effective in decreasing antibiotic prescribing and increasing guideline-adherent antibiotic prescribing by general practitioners (GPs).
For the study, Australian experts searched multiple databases for studies published up to February 2018 that met their inclusion criteria and included 15 studies that involved 18 randomized and non-randomized trials of ASPs involving pharmacists as interventionists to GPs.
Overall, researchers noted a 14% reduction in the antibiotic prescribing rate (APR) (odds ratio [OR], 0.86) and a doubling in the antibiotic prescribing adherence rate (APAR) (OR, 1.96) at 6 months median intervention follow-up. High-quality randomized trials showed an 8% decrease in APR and a 2.6-times increase in APAR. When pharmacists and GPs teamed up, ASPs were tied to a 7% lower APR and an increased APAR (OR, 1.72). Interventions involving pharmacist?infectious disease professional teams also decreased the APR (OR, 0.81) and increased the APAR (OR, 2.36).
The meta-analysis authors also noted that GP education plus prescribing feedback and group meetings were effective in both outcomes, whereas GP education, academic detailing, and workshop training were effective in APAR outcome. They add, "However, substantial heterogeneity was demonstrated."
Jan 28 J Antimicrob Chemother study
[h=3]Study: No antibiotic benefits for hospital asthma exacerbation[/h] Antibiotic therapy for patients hospitalized for asthma exacerbation isn't associated with better outcomes and shouldn't be routinely used in adults for that purpose, a research team based at the University of Massachusetts Medical School reported yesterday in JAMA Internal Medicine.
Though professional groups discourage empiric use of antibiotics for treating asthma exacerbation, use of the drugs is still high in the United States and other countries, they note. To see if adding them improves outcomes in hospitalized patients who also received corticosteroids, they looked at outcomes in a cohort of 19,811 patients hospitalized with asthma at 542 US acute care hospitals from January 2015 through December 2016 who received corticosteroids. Of the group, 8,788 (44%) got antibiotics in their first 2 days of hospitalization.
Compared with those who didn't get antibiotics, the group who got the drugs had significantly longer hospital stays, higher hospitalization costs, similar treatment failure rates, and higher risk of antibiotic-related diarrhea.
The team wrote that asthma exacerbation is an important cause of hospitalization and that decreasing inappropriate antibiotic use in that population fits well with the US Centers for Disease Control and Prevention's national strategy for combating antibiotic-resistant bacteria. They also emphasized that the short-term antibiotic treatment lacks effectiveness evidence and may be harmful and that more research is needed on strategies to curb antibiotic use in patients hospitalized for asthma exacerbation.
Jan 28 JAMA Intern Med abstract
Stewardship / Resistance Scan for Jan 29, 2019
Pharmacist interventions; Antibiotics for asthma attack
Filed Under:
Antimicrobial Stewardship
[h=3]Pooled data show pharmacists' input helpful in stewardship programs[/h] A meta-analysis of 15 studies published yesterday in the Journal of Antimicrobial Chemotherapy concluded that antimicrobial stewardship programs (ASPs) involving pharmacists are effective in decreasing antibiotic prescribing and increasing guideline-adherent antibiotic prescribing by general practitioners (GPs).
For the study, Australian experts searched multiple databases for studies published up to February 2018 that met their inclusion criteria and included 15 studies that involved 18 randomized and non-randomized trials of ASPs involving pharmacists as interventionists to GPs.
Overall, researchers noted a 14% reduction in the antibiotic prescribing rate (APR) (odds ratio [OR], 0.86) and a doubling in the antibiotic prescribing adherence rate (APAR) (OR, 1.96) at 6 months median intervention follow-up. High-quality randomized trials showed an 8% decrease in APR and a 2.6-times increase in APAR. When pharmacists and GPs teamed up, ASPs were tied to a 7% lower APR and an increased APAR (OR, 1.72). Interventions involving pharmacist?infectious disease professional teams also decreased the APR (OR, 0.81) and increased the APAR (OR, 2.36).
The meta-analysis authors also noted that GP education plus prescribing feedback and group meetings were effective in both outcomes, whereas GP education, academic detailing, and workshop training were effective in APAR outcome. They add, "However, substantial heterogeneity was demonstrated."
Jan 28 J Antimicrob Chemother study
[h=3]Study: No antibiotic benefits for hospital asthma exacerbation[/h] Antibiotic therapy for patients hospitalized for asthma exacerbation isn't associated with better outcomes and shouldn't be routinely used in adults for that purpose, a research team based at the University of Massachusetts Medical School reported yesterday in JAMA Internal Medicine.
Though professional groups discourage empiric use of antibiotics for treating asthma exacerbation, use of the drugs is still high in the United States and other countries, they note. To see if adding them improves outcomes in hospitalized patients who also received corticosteroids, they looked at outcomes in a cohort of 19,811 patients hospitalized with asthma at 542 US acute care hospitals from January 2015 through December 2016 who received corticosteroids. Of the group, 8,788 (44%) got antibiotics in their first 2 days of hospitalization.
Compared with those who didn't get antibiotics, the group who got the drugs had significantly longer hospital stays, higher hospitalization costs, similar treatment failure rates, and higher risk of antibiotic-related diarrhea.
The team wrote that asthma exacerbation is an important cause of hospitalization and that decreasing inappropriate antibiotic use in that population fits well with the US Centers for Disease Control and Prevention's national strategy for combating antibiotic-resistant bacteria. They also emphasized that the short-term antibiotic treatment lacks effectiveness evidence and may be harmful and that more research is needed on strategies to curb antibiotic use in patients hospitalized for asthma exacerbation.
Jan 28 JAMA Intern Med abstract