Impact of a restrictive antimicrobial policy on the process and timing of antimicrobial administration

Winters, Bradford D.; Thiemann, David R.; Brotman, Daniel J.

doi:10.1002/jhm.561

Cited by 11 publications

(7 citation statements)

References 26 publications

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“…The antiinfective formulary must be passed by the Therapeutics and Drugs Committee. The formulary has an immediate influence on prescribing behaviour [ 116 ].…”

Section: Recommendations Of the Guidelinementioning

confidence: 99%

Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases

et al. 2016

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IntroductionIn the time of increasing resistance and paucity of new drug development there is a growing need for strategies to enhance rational use of antibiotics in German and Austrian hospitals. An evidence-based guideline on recommendations for implementation of antibiotic stewardship (ABS) programmes was developed by the German Society for Infectious Diseases in association with the following societies, associations and institutions: German Society of Hospital Pharmacists, German Society for Hygiene and Microbiology, Paul Ehrlich Society for Chemotherapy, The Austrian Association of Hospital Pharmacists, Austrian Society for Infectious Diseases and Tropical Medicine, Austrian Society for Antimicrobial Chemotherapy, Robert Koch Institute.Materials and methodsA structured literature research was performed in the databases EMBASE, BIOSIS, MEDLINE and The Cochrane Library from January 2006 to November 2010 with an update to April 2012 (MEDLINE and The Cochrane Library). The grading of recommendations in relation to their evidence is according to the AWMF Guidance Manual and Rules for Guideline Development.ConclusionThe guideline provides the grounds for rational use of antibiotics in hospital to counteract antimicrobial resistance and to improve the quality of care of patients with infections by maximising clinical outcomes while minimising toxicity. Requirements for a successful implementation of ABS programmes as well as core and supplemental ABS strategies are outlined. The German version of the guideline was published by the German Association of the Scientific Medical Societies (AWMF) in December 2013.

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“…The antiinfective formulary must be passed by the Therapeutics and Drugs Committee. The formulary has an immediate influence on prescribing behaviour [ 116 ].…”

Section: Recommendations Of the Guidelinementioning

confidence: 99%

Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases

et al. 2016

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“…Possible disadvantages of preauthorization and restriction include perceived loss of autonomy for prescribers, the potential need for all-hours support, inaccurate or misleading information from the prescriber (leading to inappropriate recommendations), 24 and significant delay in "stat" antimicrobial administration. 54 Delay in antimicrobial administration due to the time required to obtain preauthorization and have the approval communicated to the pharmacy was not observed when studied as a process measure at WFUBMC (Ohl, unpublished data, 2008).…”

Section: Formulary Restriction and Preauthorizationmentioning

confidence: 99%

Antimicrobial stewardship for inpatient facilities

Ohl

Luther

2011

Journal of Hospital Medicine

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Antibiotic stewardship aims to improve patient care and reduce unwanted consequences of antimicrobial overuse or misuse, including lowered efficacy, emergence of antimicrobial resistance, development of secondary infections, adverse drug reactions, increased length of hospital stay, and additional healthcare costs. Recent guidelines make specific recommendations for the development of institutional programs to enhance antimicrobial stewardship. Optimally, such programs should be comprehensive, multidisciplinary, supported by hospital and medical staff leadership, and should employ evidence‐based strategies that best fit local needs and resources. An infectious diseases physician and clinical pharmacist with infectious diseases training are recommended as core members of the multidisciplinary team, although a hospitalist with interest (and perhaps additional training) in antimicrobial therapy may be able to fill the void. Program directors and core members should be compensated for their time. Principal proactive strategies—with evidence supporting their consideration—include prospective audits, with intervention and feedback, formulary restriction, and preauthorization. Other strategies include persistent one‐on‐one education, guidelines adapted to local needs, and informatics to support clinical decision making. Intervention goals are to prevent unnecessary antimicrobial starts, to streamline or de‐escalate therapy early in its course, and to convert from parenteral to oral therapy, optimize dosing, and ensure the appropriate length of therapy. Most community hospitals, if sufficiently resourced, should be able to implement a successful antimicrobial stewardship program. Evidence suggests that good antimicrobial stewardship can lead to less overall and inappropriate antimicrobial use, lower drug‐related costs, reductions in Clostridium difficile–associated disease, and, in some studies, less emergence of antimicrobial resistance. Journal of Hospital Medicine 2011;6:S4‐S15 ©2011 Society of Hospital Medicine.

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“…For example, studies have raised concerns about antibiotic restrictions delaying antibiotic treatment while also undermining trust between ASP personnel and frontline clinicians. [17][18][19] In studies across French and US hospitals, antibiotic stewards strived to collaborate with clinicians while trying to minimize perceptions that they were policing antibiotic use. 20 21 An additional concern is that restrictions of these high-risk CDI agents can lead to greater use of other broad-spectrum agents.…”

Section: Discussionmentioning

confidence: 99%

The feasibility of implementing antibiotic restrictions for fluoroquinolones and cephalosporins: a mixed-methods study across 15 Veterans Health Administration hospitals

Livorsi

Suda

Goedken

et al. 2021

Journal of Antimicrobial Chemotherapy

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Introduction The optimal method for implementing hospital-level restrictions for antibiotics that carry a high risk of Clostridioides difficile infection has not been identified. We aimed to explore barriers and facilitators to implementing restrictions for fluoroquinolones and third/fourth-generation cephalosporins. Methods This mixed-methods study across a purposeful sample of 15 acute-care, geographically dispersed Veterans Health Administration hospitals included electronic surveys and semi-structured interviews (September 2018 to May 2019). Surveys on stewardship strategies were administered at each hospital and summarized with descriptive statistics. Interviews were performed with 30 antibiotic stewardship programme (ASP) champions across all 15 sites and 19 additional stakeholders at a subset of 5 sites; transcripts were analysed using thematic content analysis. Results The most restricted agent was moxifloxacin, which was restricted at 12 (80%) sites. None of the 15 hospitals restricted ceftriaxone. Interviews identified differing opinions on the feasibility of restricting third/fourth-generation cephalosporins and fluoroquinolones. Some participants felt that restrictions could be implemented in a way that was not burdensome to clinicians and did not interfere with timely antibiotic administration. Others expressed concerns about restricting these agents, particularly through prior approval, given their frequent use, the difficulty of enforcing restrictions and potential unintended consequences of steering clinicians towards non-restricted antibiotics. A variety of stewardship strategies were perceived to be effective at reducing the use of these agents. Conclusions Across 15 hospitals, there were differing opinions on the feasibility of implementing antibiotic restrictions for third/fourth-generation cephalosporins and fluoroquinolones. While the perceived barrier to implementing restrictions was frequently high, many hospitals were effectively using restrictions and reported few barriers to their use.

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Impact of a restrictive antimicrobial policy on the process and timing of antimicrobial administration

Cited by 11 publications

References 26 publications

Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases

Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases

Antimicrobial stewardship for inpatient facilities

The feasibility of implementing antibiotic restrictions for fluoroquinolones and cephalosporins: a mixed-methods study across 15 Veterans Health Administration hospitals

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