Sequential Antibiotic Therapy: Effective Cost Management and Patient Care

Mandell, Lionel A.; Bergeron, Michel G.; Gribble, Marie J.; Jewesson, Peter J.; Low, Donald E.; Marrie, Thomas J.; Nicolle, Lindsay E.

doi:10.1155/1995/165848

Cited by 48 publications

(28 citation statements)

References 53 publications

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“…catheters, increasing the patient's comfort and mobility, and discharging the patient from the hospital earlier because the patient no longer had an i.v. catheter (5,17). The overall level of use of CIP was reduced, which was most likely caused by intervention 2, which comprised the introduction of a new guideline and an educational program.…”

Section: Discussionmentioning

confidence: 99%

Improving Quinolone Use in Hospitals by Using a Bundle of Interventions in an Interrupted Time Series Analysis

Willemsen

Cooper

Buitenen

et al. 2010

Antimicrob Agents Chemother

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The objectives of the present study were to determine the effects of multiple targeted interventions on the level of use of quinolones and the observed rates of resistance to quinolones in Escherichia coli isolates from hospitalized patients. A bundle consisting of four interventions to improve the use of quinolones was implemented. The outcome was measured from the monthly levels of use of intravenous (i.v.) and oral quinolones and the susceptibility patterns for E. coli isolates from hospitalized patients. Statistical analyses were performed using segmented regression analysis and segmented Poisson regression models. Before the bundle was implemented, the annual use of quinolones was 2.7 defined daily doses (DDDs)/100 patient days. After the interventions, in 2007, this was reduced to 1.7 DDDs/100 patient days. The first intervention, a switch from i.v. to oral medication, was associated with a stepwise reduction in i.v. quinolone use of 71 prescribed daily doses (PDDs) per month (95% confidence interval [CI] ‫؍‬ 47 to 95 PDDs/month, P < 0.001). Intervention 2, introduction of a new antibiotic guideline and education program, was associated with a stepwise reduction in the overall use of quinolones (reduction, 107 PDDs/month [95% CI ‫؍‬ 58 to 156 PDDs/month). Before the interventions the quinolone resistance rate was increasing, on average, by 4.6% (95% CI ‫؍‬ 2.6 to 6.1%) per year. This increase leveled off, which was associated with intervention 2 and intervention 4, active monitoring of prescriptions and feedback. Trends in resistance to other antimicrobial agents did not change. This study showed that the hospital-wide use of quinolones can be significantly reduced by an active policy consisting of multiple interventions. There was also a stepwise reduction in the rate of quinolone resistance associated with the bundle of interventions.The use of antimicrobial agents and the rates of antimicrobial resistance vary significantly between countries (8,9,16,27). A substantial proportion of the antimicrobial use is considered inappropriate (30). Apart from the unnecessary costs and potential harm to the patient, inappropriate use can lead to increased selection for and transmission of resistant microorganisms. A recent survey in the Amphia Hospital, Breda, Netherlands, showed that approximately 40% of all antibiotic prescriptions were considered inappropriate (e.g., unnecessary, incorrect choice, or incorrect dosage). The only independent variable associated with inappropriate use was the use of quinolones (30). In many cases the use of quinolones was incorrect because there was no indication for antimicrobial therapy, alternative antimicrobials should have been used (on the basis of hospital, national, and international guidelines), or quinolones were used intravenously (i.v.) where oral forms would suffice. The use of quinolones promotes the spread of antibiotic resistance genes by activating an SOS response, as reported by Beaber et al. (1). This means that the use of quinolones could account for the rapid ma...

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Section: Discussionmentioning

confidence: 99%

Improving Quinolone Use in Hospitals by Using a Bundle of Interventions in an Interrupted Time Series Analysis

Willemsen

Cooper

Buitenen

et al. 2010

Antimicrob Agents Chemother

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“…A literature search revealed 32 studies in support of SAT. Of these, 13 were randomized, controlled trials and 19 are nonrandomized studies (27). Both types of trials examined treatment of a variety of infections including sepsis, pneumonia, urinary tract infections and intra-abdominal infections.…”

Section: Discussionmentioning

confidence: 99%

A Multidisciplinary Hospital‐based Antimicrobial Use Program: Impact on Hospital Pharmacy Expenditures and Drug Use

Salama

Rotstein

Mandell

1995

Canadian Journal of Infectious Diseases and Medical Microbiolog

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The authors' hospital embarked on a three-component, multidisciplinary, hospital-based antimicrobial use program to cut costs and reduce inappropriate antimicrobial use. Initially, antimicrobial use patterns and costs were monitored for 12 months. For the next two years, an antimicrobial use program was implemented consisting of three strategies: automatic therapeutic interchanges; antimicrobial restriction policies; and parenteral to oral conversion. The program resulted in a reduction in the antimicrobial portion of the total pharmacy drug budget from 41.6% to 28.2%. Simultaneously, the average cost per dose per patient day dropped from $11.88 in 1991 to $10.16 in 1994. Overall, mean monthly acquisition cost savings rose from $6,810 in 1992 to $27,590 in 1994. This study demonstrates that a multidisciplinary antimicrobial use program in a Canadian hospital can effect dramatic cost savings and serve as a quality assurance activity of physician antimicrobial prescribing behaviour. Key Words: Antibiotic use program, Hospital expenditureProgramme hospitalier pluridisciplinaire d'antibiothérapie : impact sur les dépenses de la pharmacie de l'hôpital et sur l'emploi des médicaments RÉSUMÉ : L'établissement des auteurs a amorcé un programme hospitalier pluridisciplinaire d'antibiothérapie en trois volets afin de réduire les coûts et de prévenir l'emploi inapproprié des antibiotiques. Au départ, les modes d'utilisation des antibiotiques et les coûts ont été surveillés pendant 12 mois. Pendant les deux années suivantes, un programme d'antibiothérapie comportant trois stratégies a été mis en application : substitution thérapeutique automatique, politique de restriction des antibiotiques et conversion de la voie parentérale à la voie orale. Le programme a entraîné une réduction de la portion antimicrobienne du budget total de la pharmacie en terme de médicaments, soit de 41,6 % à 28,2 %. Simultanément, le coût moyen par dose par patient a chuté de 11,88 $ en 1991 à 10,96 $ en 1994. De façon globale, les économies en matière de coût mensuel d'acquisition se sont élevées de 6 810 $ en 1992 à 27 590 $ en 1994. Cette étude démontre qu'un programme d'utilisation pluridisciplinaire des antibiotiques dans un hôpital canadien peut amener des économies considérables en terme de coûts et servir de mesure d'assurance de la qualité lorsqu'il est question des habitudes d'ordonnance des médecins en matière d'antibiothérapie. 104CAN J INFECT DIS VOL 7 NO 2 MARCH/APRIL1996

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“…Decreased susceptibility to other commonly used antibiotics has also been observed (Table 4 32 ). [29][30][31] The clinical importance of these data is questionable because recruiting patients infected with resistant pathogens for clinical trials is difficult. (Figure 1 6 ).…”

Section: Pneumococcal Resistancementioning

confidence: 99%