Background Inappropriate use of antibiotics results in increased antibiotic resistance and poor efficiency, which should be avoided through pharmaceutical interventions.
Purpose To evaluate the impact of pharmaceutical interventions (PIs) on the effectiveness, safety and efficiency of treatment of Gram-positive infections in adult in-patients.
Materials and Methods For 4 months, all episodes of hospitalisation (on the same Gram positive antibiotic treatment) were evaluated of adult in-patients who were on vancomycin, linezolid or daptomycin for ≥24 hours, except for the indication of prophylaxis.
Variables related to: 1) Patient [sex, age, penicillin allergy or intolerance, hospitalisation unit (HU) and type of setting-acquired infection, diagnosis, length of stay], 2) treatment duration, drug and observance of the criteria of use established by the drug therapeutics committee (DTC), considering treatment of choice (vancomycin) and alternative treatments (linezolid and daptomycin), and 3) PIs: number, type (effectiveness, safety or efficiency), pharmacotherapeutic medication process, drug, type of PI (discontinuation of medicine, suggested therapeutic alternative, initiation of the medicine, dose individualization (DI), therapeutic/clinical drug monitoring (TCDM) and acceptance of the PI.
SPSS v. 17.0 was used.
Results 148 patients [(59% male; mean age 67 years (95% CI: 63–68) and penicillin allergy/intolerance: 10%] received 174 treatments. 76% patients were on medical HU; the infection originated in the community (85%); Diagnosis: bacteraemia (23%), skin and soft tissues infection (21%), pneumonia (20%). Median duration of hospital stay: 16 days (IQR: 9–27); of antibiotic treatment: 7 days (IQR: 3–11).
Most prescribed antibiotic: vancomycin (68%) [linezolid (28%), daptomycin (3%)]. 74% (128) of treatments fulfilled criteria established by the DTC; linezolid and vancomycin didn’t fulfil the criteria in 35/49 (71%) and 9/118 (8%) prescriptions.
251 PIs were made, 96 (38%) during initial prescription validation, representing 1 PI/treatment (IQR: 1–2) and generating 79% acceptance. Type of intervention: safety 44% (93% in vancomycin), effectiveness 24% (94% in vancomycin) and efficiency 32% (83% in linezolid). After the PI, 84% (146) treatments met DTC criteria, the percentage of non-conforming linezolid decreasing to 23/49 (47%). 155 PIs (IQR: 1–3) were performed during follow-up, with 2PIs/treatment and an 87% acceptance; these were mainly DI (48%) and TCDM (42%) interventions.
Conclusions Pharmaceutical interventions in patients with Gram-positive infections increase treatment efficiency and pursue improvement of the effectiveness and safety throughout the antibiotic treatment, reflecting the need for continued treatment follow-up to adapt it to the patient’s clinical course.
No conflict of interest.
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