UnityPoint Health-Meriter, Madison, WI, USA.
J Pharm Pract. 2021 Dec;34(6):875-881. doi: 10.1177/0897190020930979. Epub 2020 Jun 17.
Inappropriate prescribing of antibiotics has been identified as the most important modifiable risk factor for antimicrobial resistance.
The purpose of this project was to improve guideline adherence and promote optimal use of outpatient antibiotics in the emergency department (ED).
Prescribing algorithms for community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) were developed to integrate clinical practice guideline recommendations with local ED antibiogram data. Outcomes were evaluated through chart review of patients prescribed outpatient antibiotics by ED providers. The primary outcome was adherence to clinical practice guidelines, defined as the selection of an appropriate antibiotic agent, dose, and duration of therapy for each patient discharged.
When compared to patients discharged from the ED prior to algorithm implementation (N = 325), the post-implementation group (N = 353) received more antibiotic prescriptions that were completely guideline adherent (61.5% vs 11.7%, < .00001). Post-implementation discharge orders demonstrated improvement in the selection of an appropriate agent (87.3% vs 45.5%, < .00001), dose (91.5% vs 77.2%, < .00001), and duration of therapy (71.1% vs 39.1%, < .01). Additionally, fluoroquinolone prescribing rates were reduced (2.3% vs 12.3%, < .00001). A reduction in all-cause 30-day returns to the ED or urgent care was observed (15.3% vs 21.5%, = .036).
Pharmacist-driven implementation of antibiotic prescribing algorithms improved guideline adherence in the outpatient treatment of CAP, SSTI, and UTI.
抗生素的不适当使用被确定为对抗微生物药物耐药性最重要的可改变的危险因素。
本项目旨在提高指南的遵从性，并促进急诊科（ED）门诊抗生素的最佳使用。
为社区获得性肺炎（CAP）、皮肤和软组织感染（SSTI）和尿路感染（UTI）制定了处方算法，将临床实践指南建议与当地 ED 抗生素图数据相结合。通过对 ED 医生开出的门诊抗生素患者的病历进行回顾性评估来评估结果。主要结果是遵守临床实践指南，定义为为每个出院患者选择合适的抗生素药物、剂量和疗程。
与实施算法前从 ED 出院的患者（N = 325）相比，实施后组（N = 353）接受的完全符合指南的抗生素处方更多（61.5%比 11.7%，<.00001）。实施后出院医嘱在选择合适的药物（87.3%比 45.5%，<.00001）、剂量（91.5%比 77.2%，<.00001）和治疗时间（71.1%比 39.1%，<.01）方面有所改善。此外，氟喹诺酮类药物的处方率降低（2.3%比 12.3%，<.00001）。观察到所有原因的 30 天内返回 ED 或紧急护理的情况减少（15.3%比 21.5%，=.036）。
药剂师主导的抗生素处方算法的实施提高了 CAP、SSTI 和 UTI 门诊治疗的指南遵从性。
