Economic Impact of Redundant Antimicrobial Therapy in US Hospitals

Schultz, L. Wayne; Lowe, Timothy J.; Srinivasan, Arjun; Neilson, Dwight; Pugliese, Gina

doi:10.1086/678066

Cited by 48 publications

(38 citation statements)

References 32 publications

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“…Unnecessary antibiotic use contributes to the selection of multidrug resistant organisms, 27 wastes healthcare resources, 28 and likely leads to a significant number of adverse patient events annually. 29, 30 Thornhill et al identified that even short antibiotic treatment durations associated with endocarditis prophylaxis are associated with adverse reactions, including Clostridium difficile .…”

Section: Discussionmentioning

confidence: 99%

An evaluation of dental antibiotic prescribing practices in the United States

Durkin¹,

Hsueh²,

Sallah³

et al. 2017

The Journal of the American Dental Association

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Background Antibiotic prescribing practices among dentists and dental specialists in the United States (US) remains poorly understood. The purpose of our study is to compare prescribing practices between dental specialties, evaluate the duration of antibiotics prescribed by dentists, and determine variation in antibiotic selection among dentists. Methods We performed a retrospective cross-sectional analysis of dental provider specialties linked to de-identified antibiotic claims data from a large pharmacy benefits manager during the 2015 calendar year. Results As a group, general dentists and dental specialists were responsible for over 2.7 million antibiotic prescriptions, higher than several other medical and allied health provider specialties. Antibiotic treatment duration was generally prolonged and commonly included broad-spectrum agents, such as amoxicillin-clavulanate and clindamycin. Although amoxicillin was the most commonly prescribed antibiotic among all dental specialties, there was significant variation among other antibiotics selected by each specialty. The most common antibiotic treatment durations were for 7 and 10 days. Conclusions This study demonstrates that dentists frequently prescribe antibiotics for prolonged periods of time and often use broad-spectrum antibiotics. Further studies are necessary to evaluate the appropriateness of these antibiotic prescribing patterns. Practical Implications The significant variation in antibiotic selection and treatment duration identified among all dental specialties in this study population implies that further research and guidance into the treatment of dental infections is necessary to improve and standardize antibiotic prescribing practices.

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Section: Discussionmentioning

confidence: 99%

An evaluation of dental antibiotic prescribing practices in the United States

Durkin¹,

Hsueh²,

Sallah³

et al. 2017

The Journal of the American Dental Association

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“…Inappropriate antimicrobial agent use can lead to negative clinical outcomes including increased adverse drug events, Clostridioides difficile infection, antimicrobial resistance, and mortality . Although the total cost of inappropriately treated infections is unknown, redundant antibiotic use alone accounts for at least $12 million annually for United States hospitals . Involvement of clinical pharmacists in the care of infected critically ill patients' care can reduce these expenditures and improve clinical outcomes .…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] Although the total cost of inappropriately treated infections is unknown, redundant antibiotic use alone accounts for at least $12 million annually for United States hospitals. 9 Involvement of clinical pharmacists in the care of infected critically ill patients' care can reduce these expenditures and improve clinical outcomes. 10 However, the burden of recognizing and resolving inappropriate antimicrobial use is not incumbent on any specific individual; rather, all health care team members must participate in antimicrobial stewardship (AMS) efforts.…”

mentioning

confidence: 99%

Perceptions and practices for beta‐lactam antibiotic dosing, administration, and monitoring in critically ill patients: Current views and use among critical care and infectious diseases pharmacists

Hammond

McCreary

Rech

et al. 2019

J Am Coll Clin Pharm

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Purpose To elucidate considerations that infectious diseases (ID) and critical care (CC) pharmacists have regarding beta‐lactam antibiotics in critically ill adult patients in order to identify areas for practice improvement and future research. Materials and Methods A 17‐item survey was distributed to ID and CC pharmacists. Responses were characterized using frequency and descriptive statistics. Categorical variables were compared using χ2 or Fisher's exact test, as appropriate. Results Ninety‐five of 834 ID pharmacists (11.4%) and 221 of 1436 CC pharmacists (15.4%) participated. Compared with ID pharmacists, more CC pharmacists would administer renally‐excreted beta‐lactams in critically ill patients with reduced renal function without dosage adjustment for 24 hours (17% vs 34%, P = 0.002). Most respondents believed therapeutic drug monitoring would be somewhat/very important in all surveyed scenarios. ID pharmacists more frequently believed antimicrobial stewardship teams should conduct prospective audits for definitive beta‐lactam therapy (98% vs 86%, P = 0.001), develop protocols for beta‐lactam use (95% vs 85%, P = 0.019), recommend beta‐lactam dosing (98% vs 85%, P < 0.001), and recommend empirical beta‐lactam selection (95% vs 81%, P = 0.001) compared with CC pharmacists. Conclusion Beta‐lactam dosing and monitoring recommendations in critically ill adults were frequently similar between pharmacy specialties. Research should be conducted in areas where opinions differ between specialties.

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“…Such infections result in considerable morbidity, mortality, and crosstransmission in and between healthcare settings, as well as significant economic cost. 7 Antibiotic exposure is the single most important risk factor for the development of Clostridium difficile, a spore-forming bacillus that causes pseudomembranous colitis, manifesting as diarrhea that for some patients can progress to sepsis and death. 5 In fact, antibiotics are prescribed, often incorrectly, for the majority of patients hospitalized in US acute care hospitals.…”

Section: Introductionmentioning

confidence: 99%