What's New
Announcement
Posted on 09.06.01
Clinical and Economic Outcomes of a Hospital-Based Antibiotic Management Program
By Janet Weiner, MPH
In response to growing concern about the clinical and economic costs of inappropriate
use of antibiotics, many hospitals have developed programs to improve prescribing
practices. These interventions have included formulary restrictions (to limit
the availability of specific antibiotics), educational programs (to improve
caregivers' knowledge of appropriate prescribing practices), and expert reviews
of patients' antibiotic regimens.
Uenn CERTs investigators recently published an analysis of a program at the
Hospital of the University of Pennsylvania (HUP) that provides insight into
effective ways to improve antibiotic use. They published their findings in
the August 1, 2001 issue of Clinical
Infectious Diseases.
The HUP antimicrobial management program, begun in 1993, combines effective elements of existing strategies. These elements included: formulary guidelines that restricted use of broad-spectrum, expensive antibiotics; prescribing guidelines that were distributed to all residents and fellows; and creation of an Antimicrobial Management Team (AMT) to approve the use of restricted drugs.
The AMT included a doctoral-level pharmacist and an infectious-disease (ID) specialist who directed the antimicrobial management program. An AMT member reviewed requests for restricted antibiotics from 8 AM to 5 PM on weekdays; first- and second-year ID fellows reviewed requests from 5 to 11 PM on weekdays and from 8 AM to 11 PM on weekends. Between 11 PM and 8 AM, restricted drugs were released pending evaluation in the morning. The design of the program enabled the UPenn CERTs investigators to compare the effectiveness of the AMT versus the ID fellows.
In a review of 180 calls, the authors found that cases managed by the AMT had better outcomes than those managed by ID fellows, even after adjusting for other potential contributing factors. The AMT outperformed the ID fellows in all outcomes, including appropriateness of the recommendations (87% versus 47%), cure rate (64% versus 42%), and treatment failures (15% versus 28%).
Economic analyses indicated that the AMT-managed cases had lower total hospital costs (after the approval call), lower costs attributable to infection, and lower antibiotic costs than cases managed by ID fellows.
In response to these analyses, the program was reorganized to include ID fellows in the AMT, and the Director of the AMT now reviews all recommendations by the ID fellows.
Although a randomized trial is needed to confirm the effects of the program, the authors note that the team approach is promising and likely to improve antibiotic prescribing and outcomes in many hospitals.
Reference: Gross R, Morgan AS, Kinky DE, Weiner M, Gibson GA, Fishman NO. Impact of a hospital-based antimicrobial management program on clinical and economic outcomes. Clin Infect Dis 2001;33:289-95. For the abstract, Select here.