Agreement on the prescription of antimicrobial drugs

Abstract

BackgroundThere is universal awareness of the difficulties faced by doctors when prescribing antimicrobials.MethodsOver a six-month period patients hospitalized in the ICU and under treatment with antibiotics and/or antifungals were eligible to participate in the study. The data were assessed by two infectious diseases specialists. Once completed, all case forms were sent independently to both evaluators (TZSC and ARM) by e-mail. Based on the data received, the evaluator completed a form automatically generated on the e-mail and returned it to the original mailbox for further analysis. We assessed the level of agreement between infectious disease specialists and the physicians directly responsible for the decision to begin antimicrobial therapy, as well as to assess the appropriateness of the regimen prescribed.ResultsAmong the antimicrobial regimens prescribed to the 177 patients, 36 % were considered inappropriate by specialist #1 and 38 % were considered inappropriate by specialist #2. We found 78 % agreement by at least one of the infectious disease specialists with the prescribed antimicrobial regimen, and in 49 % of cases both specialists agreed with the prescribed regimen. Both disagreed with the prescribed regimen in 22 % of the cases and they disagreed between themselves in 29 % of the cases.ConclusionThis study highlights the difficulties in prescribing effective empirical antimicrobial therapy - they are of such magnitude that even two specialists in infectious diseases, well acquainted with our hospital’s resistance patterns and our patients’ profiles have considerable disagreement.

The Impact of Integrating Rapid PCR-Based Blood Culture Identification Panel to an Established Antimicrobial Stewardship Program in the United Arab of Emirates

“…Problems with assessments of optimal therapy by infectious diseases experts have been noted with overall poor inter-rater reliability (Schwartz et al, 2009). Other data has reflected this as well with infectious diseases experts disagreeing on appropriate antimicrobial therapy 30% of the time (Casaroto et al, 2015). Even with these caveats, due to the unique resistance patterns in the region, AB availability, and the internal hospital guidelines on AB usage, a pharmacist was decided to be suited to identify de-escalation and appropriateness of AB at our institution.…”

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

“…Within this criterion we also considered whether the study assessed the reliability of outcome measurement. This is especially important when considering the appropriateness of antibiotic use as it requires clinical judgement, and previous studies have shown that this can vary between assessors 36–38. Studies without controls (interrupted time series or before-after designs) were rated against three additional criteria.…”

Measuring Appropriate Antimicrobial Use: Attempts at Opening the Black Box

“…More recent reports focus on assessing appropriateness of diagnostic evaluations and resultant diagnostic accuracy [15,21,24,29–33], understanding inaccurate diagnosis leads to inappropriate antimicrobial use. Most studies define overall diagnostic accuracy based on expert case review, without detailing specific aberrations in the diagnostic process.…”

“…Most studies define overall diagnostic accuracy based on expert case review, without detailing specific aberrations in the diagnostic process. A prospective evaluation of antimicrobial use among intensive care unit patients found disagreement concerning antimicrobial choice between two independent ID physicians; however, less disagreement with regards to diagnostic accuracy and antimicrobial indication with 27% (reviewer 1) and 33% (reviewer 2) of patients without diagnostic evidence of infection [15].…”