4CPS-058 Impact of the programme for optimising the use of antibiotics after piperacilin/tazobactam’s shortage

Abstract

BackgroundPiperacillin/tazobactam (PT) is a combination of broad-spectrum antibiotics. PT is frequently used as an empirical treatment in moderate and severe infections of different origin. PT is mainly used to cover polymicrobial flora with the participation of pseudomonas aeuroginosa and other resistant Gram – bacilli. Recently, PT’s shortage has required different actions by the Program for Optimising the use of Antibiotics (PROA).PurposeTo describe the actions carried out by the PROA and to analyse the impact they have had on the PT shortage.Material and methodsA retrospective descriptive study was carried out between July and August 2017 in a hospital. Several emails were sent with the recommendations of the Spanish Agency of Medicines and Sanitary Products to the doctors who prescribe antibiotics reporting on shortage of PT. PROA made recommendations on the current prescriptions. The data collected was: type of infection, empirical/directed prescription, recommendation, acceptance of interventions and cost of treatment.ResultsWe reviewed 361 prescriptions, of which 44 were PT. Twenty-six interventions were carried out. PT’s indication was 38.5% (n=10) of the cases of intra-abdominal infection treatment, in 23.1% (n=6) urinary tract infection, in 19.2% (n=5) respiratory infection, in 15.4% (n=4) bacteremia and 3.8% (n=1) skin infection and soft tissue. There were 84% (n=21) of empirical prescriptions. Proposed recommendations were 57.7% (n=15) of the cases switching to another antibiotic (carbapenems, fourth-generation cephalosporins), in 34.6% (n=9) it was recommended to scale to a lower spectrum antibiotic (ertapenem, third-generation cephalosporins, penicillins or quinolones) and in the remaining 7.7% (n=2) to suspend it. Acceptance of the recommendations was 84.6% (n=22), although in 96.2% (n=25) of the cases PT ceased to be used. During this period, the cost per patient/day increased from €9.99 to €18.74 at the expense of a patient who was prescribed ceftolozano/tazobactam.ConclusionAcceptance of the PROA’s recommendations was elevated. PT’s shortage involved an increase in cost per patient/day. PROA allowed improvement actions in the use of antibiotics, becoming more relevant in periods of shortage.References and/or AcknowledgementsTo everyone in the Pharmacy and Internal Medicine Departments who have collaborated in the collection of data and analysisNo conflict of interest