Interventions to improve antibiotic prescribing at hospital discharge: A systematic review

Daniels, Lindsay M.; Weber, David J.

doi:10.1017/ice.2020.367

Cited by 13 publications

(14 citation statements)

References 15 publications

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“…Some of the proposed models include developing an institutional guidance for oral step-down antibiotic and duration, pharmacy-led discharge review, providing discharge advice as part of routine ASP interventions, and incorporating antibiotic timeout at discharge. 9,10 The limitation of our study is its small sample size in a single center, which limits its generalizability. The retrospective nature of this study may have impeded the accuracy of our assessment.…”

Section: Discussionmentioning

confidence: 97%

Outpatient antibiotics study investigating stewardship potential-transitions of care (OASIS-T)

Chung

Chong

Somani

et al. 2020

Infect. Control Hosp. Epidemiol.

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Section: Discussionmentioning

confidence: 97%

Outpatient antibiotics study investigating stewardship potential-transitions of care (OASIS-T)

Chung

Chong

Somani

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…Few studies have described AS efforts at discharge and their impact on antimicrobial prescribing. [15][16][17][18][19] Most studies focus on antimicrobial appropriateness before and after AS intervention, although intervention strategies vary between studies. Yogo et al performed a quasi-experimental, retrospective cohort study that used an institutional guideline with recommendations for oral step-down therapy and treatment duration in conjunction with prospective audit with real-time feedback to prescribers.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, Daniels and Weber performed a systematic review assessing interventions to improve antimicrobial prescribing at hospital discharge. 19 However, only a few studies were identified for inclusion (n = 6). The authors concluded that AS interventions focused on improving discharge antimicrobial prescribing need further study.…”

Section: Discussionmentioning

confidence: 99%

Hospital Discharge: An Opportune Time for Antimicrobial Stewardship

et al. 2021

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Background: Approximately 30% of antimicrobials prescribed in the outpatient setting are unnecessary and up to 50% are inappropriate. Despite this, antimicrobial stewardship (AS) efforts mostly focus on the inpatient setting, and limited data describe AS interventions at hospital discharge. Acknowledging the potential value of discharge AS, we used our existing resources to review discharge oral antimicrobial prescriptions. Objective: The primary objective of this retrospective, single-center study was to evaluate the impact of an AS program on discharge oral antimicrobial prescriptions. Methods Discharge oral antimicrobial prescriptions sent to our hospital-operated outpatient pharmacy, reviewed by an infectious diseases (ID) pharmacist, and recorded into our data collection tool from September 1, 2020, to February 28, 2021, were evaluated retrospectively. The primary outcome was to identify the frequency a drug-related problem (DRP) was identified by an ID pharmacist. Secondary outcomes included DRP characterization, percentage of prescriptions with interventions, intervention acceptance rate, and reduction in antimicrobial days dispensed at discharge when interventions to limit treatment duration were accepted. Results: Of the 803 discharge oral antimicrobial prescriptions reviewed, at least 1 DRP was identified in 43.1% (346/803). The most frequently identified DRPs pertained to treatment duration, drug selection, and dose selection. At least 1 intervention was recommended in 42.8% (344/803) of prescriptions. In total, 438 interventions were made and the acceptance rate was 75.6% (331/438). The most common types of interventions included recommendations for a different duration, a different dose or frequency, and antimicrobial discontinuation. When interventions to reduce treatment duration were accepted, the median (interquartile range) number of antimicrobial days decreased from 8 (5-10) days to 4 (0-5.5) days ( P < 0.001). Conclusion and Relevance: An ID pharmacist’s review of discharge oral antimicrobial prescriptions sent to our hospital-operated outpatient pharmacy resulted in identification of DRPs and subsequent interventions in a substantial number of prescriptions.

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“…There is a particular focus on antimicrobial stewardship, which refers to the efforts made to ensure that antimicrobials are used only when necessary and appropriate. It was first established as a set of “responsible use” policy measures to combat AMR in human hospitals ( 35 ) and is now used widely in human medicine ( 36 , 37 ). In food animal production, antimicrobial stewardship similarly refers to a commitment to judicious use of antimicrobials ( 38 – 40 ), including efforts to limit inappropriate usage, to optimise the choice, dose rate, route, and duration of therapy to maximise clinical cures, and to minimise the emergence and spread of AMR.…”

Section: The Evidence Consideredmentioning

confidence: 99%

Mastitis Control and Intramammary Antimicrobial Stewardship in Ireland: Challenges and Opportunities

McAloon

Boloña

et al. 2022

Front. Vet. Sci.

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The Veterinary Medicines Regulation (EU 2019/6) came into force in all EU member states on 28 January 2022. This regulation places particular emphasis on prudent and responsible antimicrobial use in food animal production. Key changes include restrictions on the prophylactic use of antimicrobials in animals, and the possibility to reserve certain antimicrobials for humans only. The Regulation presents challenges to the Irish dairy industry, particularly with respect to current approaches to dry cow therapy. In response, the CellCheck technical working group (TWG, a technical group working in support of CellCheck, the national mastitis control programme) have developed pragmatic national and farm-level recommendations in support of improved mastitis control and intramammary antimicrobial stewardship in the Irish dairy industry. This paper outlines these recommendations, and provides an overview of the evidence considered to inform the TWG during its work (including the Regulation, policy perspectives, international best-practice, international scientific reviews and specific Irish challenges). In many key areas of concern, the TWG recognises the challenges in seeking to shape recommendations in the absence of robust and practical scientific evidence. For this reason, some of the recommended actions are pragmatic in nature, informed by national and international experiences. Periodic programme review will be needed, informed by ongoing monitoring of key performance indicators, to identify those actions that are most effective in an Irish context.

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Interventions to improve antibiotic prescribing at hospital discharge: A systematic review

Cited by 13 publications

References 15 publications

Outpatient antibiotics study investigating stewardship potential-transitions of care (OASIS-T)

Outpatient antibiotics study investigating stewardship potential-transitions of care (OASIS-T)

Hospital Discharge: An Opportune Time for Antimicrobial Stewardship

Mastitis Control and Intramammary Antimicrobial Stewardship in Ireland: Challenges and Opportunities

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