Evaluation of an antibiotic intravenous to oral sequential therapy program

AIM: This study was designed to analyse the drug consumption difference and economic impact of an antibiotic sequential therapy focused on quinolones. METHOD: We studied the consumption of quinolones (ofloxacin/levofloxacin and ciprofloxacin) 6 months before and after the implementation of a sequential therapy program in hospitalised patients. It was calculated for each antibiotic, in its oral and intravenous forms, in defined daily dose (DDD/100 stays per day) and economical terms (drug acquisition cost). At the beginning of the program ofloxacin was replaced by levofloxacin and, since their clinical uses are similar, the consumption of both drugs was compared during the period. RESULTS: In economic terms, the consumption of intravenous quinolones decreased 60% whereas the consumption of oral quinolones increased 66%. In DDD/100 stays per day, intravenous forms consumption decreased 53% and oral forms consumption increased 36%. CONCLUSIONS: Focusing on quinolones, the implementation of a sequential therapy program based on promoting an early switch from intravenous to oral regimen has proved its capacity to alter the utilisation profile of these antibiotics. The program has permitted the hospital a global saving of 41420 dollars for these drugs during the period of time considered.     

Results of an antimicrobial control program at a university hospital.

PURPOSE: The results of the first five years of an ongoing antimicrobial control program are reported. METHODS: In 1998, a multidisciplinary antimicrobial subcommittee of the pharmacy and therapeutics committee of a university hospital was formed and charged with making formulary interventions in an effort to reduce rising antimicrobial resistance rates and drug expenditures. In 1999, a number of measures were implemented for controlling antimicrobial use. Selected antimicrobials with the potential for inappropriate use or whose inappropriate use had been documented were placed in the control of physicians in the infectious diseases (ID) division. Prior approval by an ID physician was required before the pharmacy could dispense these agents. Other key interventions included removal of ceftazidime and cefotaxime from the formulary, restriction of vancomycin and carbapenem use, and replacement of ciprofloxacin with levofloxacin as the sole fluoroquinolone on the formulary. Data regarding antimicrobial use and expenditures between 1998 and 2002 were compared and analyzed. RESULTS: Antimicrobial use was reduced by 80% for third-generation cephalosporins and 15% for vancomycin following the implementation of the new antimicrobial policies. Antimicrobial-resistance patterns for many important gram-negative pathogens, including Pseudomonas aeruginosa, demonstrated a reversal of previous increases. In addition, the rate of methicillin-resistant Staphylococcus aureus decreased by an average of 3% each year from 1999 to 2002. Pharmacy expenditures for all antimicrobials, including antiviral, antifungal, and antibacterial agents, decreased 24.7%, with a cumulative cost saving of 1,401,126 US dollars, without inflation assumptions. CONCLUSION: The implementation of an antimicrobial control program decreased the use of selected antimicrobial agents and resulted in substantial reduction of expenditures for antimicrobials.     

Antimicrobial stewardship solutions with a smart innovative tool

BackgroundAntimicrobial consumption has been increasing lately. Hence, effective strategies are required to control antimicrobial use and decrease the development of antimicrobial resistance.ObjectiveTo evaluate the impact of the use of a mobile app on the implementation of antimicrobial stewardship program (ASP) interventions.MethodsThis was a longitudinal study conducted at El-Nile Badrawi Hospital in Cairo, Egypt, on inpatients receiving antimicrobials from January 2018 to December 2019. The study included 2 phases: the preimplementation phase, which included a paper-based ASP developed according to the Centers for Disease Control and Prevention Core Elements of Hospital Antibiotic Stewardship Programs 2014, and the mobile app phase where the MEDIcare Pro mobile app was developed and used in ASP intervention implementation. The study outcomes were antimicrobial consumption and cost, length of hospital and intensive care unit (ICU) stay, 30-day mortality rate and readmission rate, and detection of drug-related problems (DRPs).ResultsThe mobile app statistically significantly decreased antimicrobial consumption from 75.1 defined daily dose (DDD)/100 bed-days in the preimplementation phase to 64.65 DDD/100 bed-days in the mobile app phase, with a total cost savings of E£1,237,476. There was a significant reduction in the length of ICU stay, with a mean difference of 1.63 days between the 2 phases, but no significance was detected regarding length of hospital stay or readmission rate. There was a statistically significant decrease in mortality rate from 1.17% in the preimplementation phase to 0.83% in the mobile app phase (P = 0.02). The frequency of DRPs detected by pharmacists statistically significantly increased from 0.54/100 bed-days in the preimplementation phase to 3.23/100 bed-days in the mobile app phase.ConclusionThe use of a mobile app was found to be effective, applicable, and usable in guiding health professionals on rational antimicrobial use.     

Evaluating Incorporation of Drug Restrictions into Computerized Drug Order Entries after Transition to an Electronic Health Record

Background:

Incorporation of drug restriction policy into electronic drug order entries (DOEs) can promote responsible medication use and resource utilization when implemented systematically.

Objective:

To identify drugs that require further incorporation of formulary restriction policy into their DOEs after migration to an electronic health record with computerized prescriber order entry (CPOE).

Methods:

After transition to CPOE, test orders for formulary restricted drugs were entered in the CPOE environment. Data were collected about rationale for drug restriction, type of formulary restriction, presence of incorporation of restriction policy into the DOE, and whether incorporation was consistent with a recommended method. Restricted drugs requiring revision of policy incorporation into their DOEs were analyzed to create a prioritized task list based on rationale for the restriction.

Results:

Of all restricted drugs, 63.6% (287/451) did not have restriction policy incorporated into their DOEs consistent with the recommended method and therefore required revision. Eighteen percent (81/451) of restricted drugs had no incorporation of restriction policy in their DOEs. Safety was the rationale for restriction in 21% (17/81) of these, which received highest priority for revision. When drugs were orderable but restricted, 61.9% (78/126) lacked optimal incorporation of policy in DOEs to promote adherence. When drugs were not orderable, 64% (206/322) did not provide guidance to formulary alternatives in DOEs when they should have.

Conclusion:

After transition to CPOE, almost two-thirds of all analyzed restricted drugs lacked optimal incorporation of formulary restriction policies in their DOEs. DOEs with restrictions related to safety reasons were among those most frequently requiring revision. Some DOEs can better promote adherence and provide guidance to prescribers through revision. Predefined, systematic implementation strategies should be used during changes in computerized drug use processes.     

Patterns of systemic antibiotic use in a tertiary hospital in Israel in the years 1998-2000

OBJECTIVES: To investigate the pattern of antibiotic use in the hospital over a 3-year period according to individual drugs and hospital departments. SETTING: 335 adult beds of a tertiary hospital in Northern Israel during the years 1998-2000. An antibiotic control policy restricts the use of the most expensive antibiotics and those with broad spectrum of activity and a major impact on bacterial resistance. METHODS: The ATC/DDD and DU 90% methodologies were used. The use of antibiotics was expressed as the number of defined daily doses (DDD) per 100 bed-days. RESULTS: The total antibiotic use varied during the study period from 93.7-101.0 DDD/100 bed-days (p < 0.1). Thirteen drugs accounted for 90% of the total volume. The use of broad spectrum penicillins was the highest of all drugs followed by cephalosporins and oral quinolones. The highest rates of antibiotic use were found in the departments of ENT, urology, gynecology and orthopedics and in the intensive care unit (ICU). The total restricted antibiotics use was 7.2 DDD/100 bed-days and was the highest in the ICU. CONCLUSIONS: The ATC/DDD methodology provided delineation and interpretation of antibiotic usage patterns in the hospital. Although the overall use is higher then that found in several reports from European hospitals, stratification by individual drugs and by hospital department yielded similar trends.     

The effect of formulary restriction in the use of antibiotics in an Italian hospital

OBJECTIVE: To compare the expenditure and usage of antibiotics at the San Martino Teaching Hospital, a 2500-bed hospital in Genoa, Italy, before and after the implementation of an antibiotic control program that streamlined the hospital formulary and the creation of a restricted group of antibiotics requiring approval before use. METHODS: Usage and expenditure data for all antibiotics were collected from 1996 to 1998. Antibiotic usage was standardised by defined daily doses (DDDs) per 100/patient-days. Cost data were expressed in Euros. Changes in antibiotic usage was determined by comparing the mean usage during 1996 and 1997, the period before the implementation of the antibiotic control program, to 1998 when the streamlined formulary and restricted group of antibiotics, controlled by the Infectious Disease Team (IDT). were initiated. The Wilcoxon rank sign test was used to determine statistical significance of the changes in overall antibiotic use; a P value of less than 0.05 was considered significant. RESULTS: After the implementation of the antibiotic control program, overall antibiotic usage decreased by 8.5%, 28.00 DDD/100 patient-days during 1996-1997 to 25.62 DDD/100 patient-days during 1998. The control program resulted in overall savings of 342,927 Euros after the first year of implementation. The usage and expenditure in the restricted group of antibiotics decreased by 78.5% and 53.5%, respectively, (P=0.03). Restricting the use of ceftazidime and imipenem accounted for the majority of the decreased usage and savings. In the non-restricted group of antibiotics, usage increased only by 32.6% resulting in a net reduction of 46.3% in all antibiotic use. CONCLUSION: Although antibiotic control programs have been successful in other countries, this represents the first attempt at successful antibiotic control in a large Italian teaching hospital. Streamlining the formulary to control antibiotic choices and the creation of a restriction program using the expertise of infectious disease physicians resulted in significant reductions in the use of and expenditure for antibiotics.     

Differences in antidiabetic drug utilisation between three different health systems in the same national region

Summary The consumption of antidiabetic drugs in a Spanish region (Extremadura) in the period 1986–1987 has been investigated by the defined daily dose (DDD) method.The study was done in three health care systems in the region: civil servants (Mutualidad de Funcionarios Civiles del Estado: MUFACE) armed forces group (Instituto Social de las Fuerzas Armadas: ISFAS) and the national system (Instituto Nacional de la Salud: INSALUD). The total consumption of antidiabetic drugs varied three-fold, ranging from 5,73 DDD per 1000 inhabitants per day (3,71 DDD per 1000 inhabitants per day for oral antidiabetic drugs and 2,02 DDD per 1000 inhabitants per day for insulin) in the civil servant group to 15,82 DDD per 1000 inhabitants per day (12 DDD per 1000 inhabitants per day for oral antidiabetic drugs and 3,82 DDD per 1000 inhabitants per day for insulins) in the armed forces. The differences were more pronounced for oral antidiabetics than for insulins. The utilization of insulin among the civil servants was about half of that by the two other groups. Of oral antidiabetics, sulphonylureas were the most frequently used by the three groups, and within them glibenclamide accounted for more than half of the DDDs, while biguanides were scarcely used in any group. The differences are difficult to assess, since they could be due to several factors, such as age-differences in the population studied, different prescribing habits, and differences in sociocultural level. The results justify further comparative studies of drug utilization in different health systems within the same region.     

Cutaneous reactions to drugs. An analysis of spontaneous reports in four Italian regions

AIMS: Cutaneous manifestations are frequently reported in association with drug use. The aim of this study was to analyse the skin reactions reported to the spontaneous surveillance systems of four Italian regions (Friuli Venezia Giulia, Lombardy, Sicily and the Veneto), and correlate the reports with estimated drug consumption during the same period, paying particular attention to the reactions to antimicrobial agents and nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS: All of the adverse drug reactions (ADRs) reported spontaneously between January 1996 and December 1997 to the surveillance systems of four Italian regions (a total population of about 20 million people) were analysed by a panel of experts including dermatologists. On the basis of the Critical Term List of the World Health Organization (WHO), the reactions were classified as either serious or nonserious events. Drug consumption was expressed as a daily defined dose (DDD)/1000 inhabitants/day. RESULTS: A total of 2224 adverse skin reaction reports (44.7% of all of the reported ADRs) were identified, making a reporting rate of about 5.5 per 100 000 inhabitants/year. The female/male ratio was 1.58, and the reporting rate progressively increased with age. The drug categories with the highest number of cutaneous reactions were antimicrobials, followed by NSAIDs, analgesics and radiology contrast media. There was a total of 372 (16.9%) serious reaction reports, the most frequent being angioedema (171 cases), erythema multiforme (68 cases) and photosensitivity (37 cases). Co-trimoxazole, followed by the cephalosporins and fluoroquinolones, were associated with the highest consumption-related reporting rate among the antimicrobials, and aspirin and dipyrone among the NSAIDs and analgesics. CONCLUSIONS: Spontaneous reports from four Italian regions revealed that the skin was the organ most frequently affected by ADRs. The paper shows the validity of a regional decentralized system in Italy.     

Use of antibiotics at hospitals in Stockholm: a benchmarking project using internet

PURPOSE: To evaluate the internet way of feedback to prescribing physicians, providing data on antimicrobial use and to assess the applicability of the DU90% (i.e. Drug Utilisation 90%--the number of drugs accounting for 90% of the volume of usage in defined daily doses, (DDDs)) methodology in the hospital setting. METHODS: Antimicrobial drug use was evaluated in all major departments in seven hospitals in Stockholm in the year 2000. All data were presented anonymously on www.janusinfo.org. Aggregate data on antimicrobial drug use were expressed as the number of DDDs and costs per 100 bed-days. We focused on the number of drugs accounting for 90% of the volume (DDD), including the level of adherence to guidelines. The chief physicians assessed this feedback by a questionnaire. RESULTS: The number of DDDs/100 bed-days varied among different clinics and ranged from 39 to 57 (internal medicine) to 102 to 161 (infectious disease). The cost per 100 bed-days varied more than two-fold. The number of different antibiotics within the DU90% segment ranged from 9 to 13 (orthopaedic clinics) to 16 to 23 (infectious disease). According to the questionnaire, data were considered to be clearly presented and physicians would like to receive this kind of reports in the future, not only for antibiotics but also for other drugs. CONCLUSION: Presenting physicians with aggregate data on drug use via internet could provide a stimulus for prescribing improvement.     

带量采购政策下他汀类药物在上海某院的应用情况分析

目的:探讨上海市第三批带量、国家"4+7"带量采购政策在上海某医院的实施效果及对该院他汀类药物使用情况的影响.方法:收集该院信息系统中上海市第三批带量采购执行前(2018年2月10日-8月31日)、上海市第三批带量采购执行后(2018年9月1日-2019年3月19日)、"4+7"带量采购执行后(2019年3月20日-1...     

118例下呼吸道感染老年患者应用抗菌药物的费用及疗效分析

目的 :了解下呼吸道感染老年患者抗菌药物应用情况 ,评价其用药合理性。方法 :对118例下呼吸道感染老年患者住院期间应用抗菌药物的资料作统计 ,并按抗菌药物费用分档、费用比、DDD值、DUI等因素进行分析、评价。结果 :本组应用抗菌药物费用2257 86元 ,抗菌药物费用占住院总费用、总药费的比例分别为25 %和46 % ;疗程 (24 1±8 1)d ;治愈109例 ,好转6例 ,治愈率92 4 %。结论 :本组临床抗菌药物的应用基本合理     

我院1999年9月～2000年3月抗菌药物应用状况的调查与分析

目的 :了解我院住院患者应用抗菌药物的状况。方法 :按全院床位数的1/3左右抽取出院患者的病历 ,按预先制定的“临床科室应用抗菌药物调查表”逐项填写 ,最后进行综合分析。结果 :单一用药、用一线药均在半数以上 ,对于重症感染、混合感染采用联合用药得当 ;抗菌药物应用率较高 (79 64 % ) ,特别是手术患者预防术后感染几乎100 %应用抗菌药 ;药物选择起点高 ,新、特、贵药排序居前 ;联合用药过于普遍 ;依据经验治疗居多 ,菌培药敏试验率仅占10 50 %。结论 :合理用药仍是主流 ,应针对存在问题制定相应措施     

Antimicrobial use and drug–drug interactions among nursing home residents in Singapore: a multicentre prevalence study

Background With the Ministry of Health’s projected increase in nursing home beds and optimization of antimicrobial use in health care settings, it is therefore timely to consider baseline prevalence and patterns of antimicrobial use at nursing homes in Singapore as well as to evaluate the prevalence of potential clinically significant drug–drug interactions involving antimicrobials. Objective The primary objective was to determine the prevalence and patterns of antimicrobial use at nursing homes in Singapore. The secondary objective was to evaluate the prevalence of potential clinically significant drug–drug interactions involving antimicrobials. Setting Four nursing homes in Singapore. Method A retrospective cross-sectional study was conducted among nursing home residents. The antimicrobial prevalence, defined daily doses, days of therapy, and potential drug–drug interactions were determined using data from archived resident medication prescribing and administration records. Main outcome measure Prevalence and patterns of antimicrobial use, drug–drug interactions involving antimicrobials. Results Among 707 residents (mean age: 80.7?±?8.8 years, female: 57.1%), 10% used antimicrobials during the study month, with a 1-day point prevalence of 3%. The utilization rates of antimicrobials were 28.9 defined daily doses/1000 resident-days and 24.8 days of therapy/1000 resident-days. Potential drug–drug interactions involving antimicrobials were identified among 32 of the 70 (46%) residents who were prescribed antimicrobials. Of these, 26 (81%) residents had 43 potential clinically significant drug–drug interactions. Conclusions The prevalence and utilization rates of antimicrobial use in Singapore nursing homes appear to be low. Yet, potential clinically significant drug–drug interactions are prevalent.