Gardiner Sharon J, Metcalf Sarah Cl, Werno Anja, Doogue Matthew P, Chambers Stephen T
Antimicrobial Stewardship Pharmacist, Departments of Infectious Diseases, Clinical Pharmacology and Pharmacy, Christchurch Hospital, Canterbury District Health Board, Christchurch.
Infectious Diseases Physician, Department of Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch.
N Z Med J. 2020 Apr 3;133(1512):22-30.
To assess a persuasive multimodel approach to decreasing unnecessary intravenous (IV) clarithromycin use for community-acquired pneumonia (CAP) in Canterbury District Health Board (CDHB) hospitals.
In December 2013, CDHB guidelines for empiric treatment of CAP changed to prioritise oral azithromycin over IV clarithromycin. The multimodel approach we used to implement this change included obtaining stakeholder agreement, improved guidelines access, education and pharmacist support. The impact of the intervention was evaluated by comparing macrolide usage and expenditure for the four years pre- and post-intervention.
Mean annual clarithromycin IV use decreased by 72% from 6.4 to 1.8 defined daily doses (DDDs) per 1,000 occupied bed days (OBDs) post-intervention, while oral azithromycin increased by 833% (4.2 to 39.2 DDDs per 1,000 OBDs). Concurrently, oral clarithromycin use decreased by 91% (32.9 to 2.9 DDDs per 1,000 OBDs), and roxithromycin by 71% (17.0 to 5.0 DDDs per 1,000 OBDs). Mean annual total macrolide use decreased by 21% (68.2 to 53.9 DDDs per 1,000 OBDs), while expenditure decreased by 69% mainly through avoided IV administration.
A persuasive multimodel approach to support adoption of CAP guidelines produced a sustained decrease in IV clarithromycin use, which may have clinical benefits such as reduced occurrence of catheter-related complications.
评估一种有说服力的多模式方法，以减少坎特伯雷地区卫生局（CDHB）医院中社区获得性肺炎（CAP）患者不必要的静脉注射克拉霉素的使用。
2013年12月，CDHB关于CAP经验性治疗的指南发生了变化，优先选择口服阿奇霉素而非静脉注射克拉霉素。我们用于实施这一变化的多模式方法包括获得利益相关者的同意、改善指南获取途径、开展教育以及药剂师支持。通过比较干预前后四年的大环内酯类药物使用情况和支出，评估该干预措施的影响。
干预后，每1000个占用床位日（OBDs）的克拉霉素静脉使用量从6.4限定日剂量（DDDs）降至1.8 DDDs，年均降幅为72%，而口服阿奇霉素增加了833%（从每1000个OBDs的4.2 DDDs增至39.2 DDDs）。同时，口服克拉霉素的使用量下降了91%（从每1000个OBDs的32.9 DDDs降至2.9 DDDs），罗红霉素下降了71%（从每1000个OBDs的17.0 DDDs降至5.0 DDDs）。年均大环内酯类药物总使用量下降了21%（从每1000个OBDs的68.2 DDDs降至53.9 DDDs），而支出下降了69%，主要是通过避免静脉给药实现的。
一种支持采用CAP指南的有说服力的多模式方法使静脉注射克拉霉素的使用持续减少，这可能具有临床益处，如减少导管相关并发症的发生。
