Jantarathaneewat Kittiya, Apisarnthanarak Anucha, Limvorapitak Wasithep, Weber David J, Montakantikul Preecha
Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand.
Department of Pharmaceutical care, Faculty of Pharmacy, Thammasat University, Pathum Thani 12120, Thailand.
Antibiotics (Basel). 2021 Apr 17;10(4):456. doi: 10.3390/antibiotics10040456.
The antibiotic stewardship program (ASP) is a necessary part of febrile neutropenia (FN) treatment. Pharmacist-driven ASP is one of the meaningful approaches to improve the appropriateness of antibiotic usage. Our study aimed to determine role of the pharmacist in ASPs for FN patients. We prospectively studied at Thammasat University Hospital between August 2019 and April 2020. Our primary outcome was to compare the appropriate use of target antibiotics between the pharmacist-driven ASP group and the control group. The results showed 90 FN events in 66 patients. The choice of an appropriate antibiotic was significantly higher in the pharmacist-driven ASP group than the control group (88.9% vs. 51.1%, < 0.001). Furthermore, there was greater appropriateness of the dosage regimen chosen as empirical therapy in the pharmacist-driven ASP group than in the control group (97.8% vs. 88.7%, = 0.049) and proper duration of target antibiotics in documentation therapy (91.1% vs. 75.6%, = 0.039). The multivariate analysis showed a pharmacist-driven ASP and infectious diseases consultation had a favorable impact on 30-day infectious diseases-related mortality in chemotherapy-induced FN patients (OR 0.058, 95%CI:0.005-0.655, = 0.021). Our study demonstrated that pharmacist-driven ASPs could be a great opportunity to improve antibiotic appropriateness in FN patients.
抗生素管理计划（ASP）是发热性中性粒细胞减少症（FN）治疗的必要组成部分。由药剂师主导的ASP是提高抗生素使用合理性的有效方法之一。我们的研究旨在确定药剂师在FN患者的ASP中的作用。我们于2019年8月至2020年4月在泰国法政大学医院进行了前瞻性研究。我们的主要结果是比较药剂师主导的ASP组和对照组中目标抗生素的合理使用情况。结果显示，66例患者发生了90次FN事件。药剂师主导的ASP组中选择合适抗生素的比例显著高于对照组（88.9%对51.1%，<0.001）。此外，药剂师主导的ASP组中作为经验性治疗选择的给药方案的合理性高于对照组（97.8%对88.7%，=0.049），且在记录治疗中目标抗生素的使用时长合适的比例也更高（91.1%对75.6%，=0.039）。多变量分析显示，药剂师主导的ASP和传染病会诊对化疗诱导的FN患者30天内与传染病相关的死亡率有有利影响（OR 0.058，95%CI：0.005 - 0.655，=0.021）。我们的研究表明，药剂师主导的ASP可能是提高FN患者抗生素使用合理性的一个好机会。
