Background Despite the benefits of antibiotic re-evaluation (decrease in the emergence of bacterial resistance, adverse effects and costs) physicians do not systematically trace it. In our hospital, after the implementation in June 2013 of a day-2 antibiotic re-evaluation (AR) module in the prescription software and three awareness periods of prescribers, only 53% of AR were done for 10 high-risk antibiotics.
Purpose The aim of this work was to study the feasibility of a follow-up by pharmacy of antibiotic re-evaluation.
Material and methods All antibiotic re-evaluation of the 10 antibiotics followed in 2017 were analysed by pharmacy from the AR module (status of prescriber, indication, date of AR). This analysis was compared with the number of patients initiated under these antibiotics and delivered by the pharmacy. In order to determine the feasibility of follow-up, all antibiotic prescriptions were analysed during 2 weeks to know the number of prescriptions and re-evaluation at day-2 and day-7 delivered by the pharmacy per day.
Results In 2017, there were 464 patients treated with linezolid and only 34 AR were traced at day-2 (7.3%). For other antibiotics, AR module use rate was: Imipenem/Cilastatine 38/308 (12.3%), Ceftazidime 32/225 (14.2%), Levofloxacine 130/590 (22%) and Cefepime 42/137 (30.7%). The AR was made on average at 4.3 days. A mean of 85 antibiotic prescriptions were analysed and delivered by the pharmacy per day. Among these prescriptions a daily mean of 31 prescriptions were sent to the pharmacy at day-2 and four at day-7. To enable the feasibility of follow-up, infectious disease physicians have validated an exhaustive list of infections requiring antibiotic therapy for more than 7 days, based on new international antibiotic therapy duration recommendations. This list allows the pharmacy to check the indication of treatment and to dispense antibiotics or not at day-7.
Conclusion Pharmacists have a crucial role to play in the AR through its follow-up. A day-7 AR module will be added in early 2019 to our prescription software. The day-7 follow-up of all antibiotic prescriptions by the pharmacy and its ability to halt dispensing might reduce the emergence of bacterial resistance and limit antibiotic consumption through a better traceability of AR.
References and/or acknowledgements No conflict of interest.
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