Background In hospital settings (HS), pharmacists´ interventions (PI) can contribute to rational use of antimicrobials. Due to scarce resources, the pharmacist’s time has to be dedicated to interventions with impact on patient outcomes and costs.
Purpose A systematic review was conducted to summarise published evidence regarding clinical and/or economic outcomes of PI related to antimicrobials in HS to estimate the impact of PI and to identify strategies with higher impact.
Material and methods A PubMed search of papers published from 2003 to March 2016 was conducted using the terms (’pharmacist*’ OR ‘clinical pharmacist*’) AND (’antimicrobial*’ OR ‘antibiotic*’ OR ‘anti infective*’). Additional references were identified from citations. Inclusion criteria were: comparative studies that assessed clinical or economic impact of PI regarding antimicrobials in HS or those that evaluated intermediate outcomes, microbiological impact or appropriate antimicrobial prescription (AAP). Exclusion criteria were: studies in paediatric, primary care or community settings, and evaluations of multidisciplinary teams. We collected: study design, type of PI, impact of PI and acceptance by physicians. Risk of bias of studies was analysed using Cochrane´s tool.1
Results 23 studies were included; all had a high risk of bias. Most frequent design was before and after without a control group (57%) and 83% were single centre studies. Identified PI were grouped into three types: specific recommendations (SR) (in 22 studies), policy (in 4) and education (in 3). Six studies combined various strategies. A significant positive impact of PI was found in 14 of 17 (82%) studies that evaluated costs, in 11 of 15 (73%) that studied AAP, in 9 of 18 (50%) that analysed clinical outcomes (CO), in 1 of 2 (50%) that assessed microbiological outcomes (MO) and in 3 of 7 (43%) that evaluated adverse drug events (ADE). A combination of SR, education and policy had the highest impact on AAP, CO and costs; SR and education on MO; and dose adjustment on ADE. 70–92% of recommendations were accepted.
Conclusion Pharmacists´ interventions regarding antimicrobials had a positive impact on appropriate prescribing and patient outcomes, and decreased costs. Combinations of strategies seems to be superior to single strategies. Quality of published studies is poor and better studies are necessary to confirm these results.
References and/or acknowledgements 1. Available at http://handbook.cochrane.org/chapter_8/8_5_the_cochrane_collaborations_tool_for_assessing_risk_of_bias.htm
No conflict of interest
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