In this episode, I’ll discuss opportunities for antibiotic stewardship before hospital discharge.
A primary focus of antibiotic stewardship programs is to reduce unnecessary antibiotic use among hospital inpatients.
Reducing unnecessary antibiotic use upon hospital discharge is not a popular focus among the majority of stewardship programs. However, a significant opportunity for stewardship exists at the point of hospital discharge, and this was recently highlighted by a retrospective multi-center study published in Clinical Infectious Diseases.
The article’s authors analyzed patients treated in 46 different hospitals for pneumonia and UTI. They looked for antibiotic overuse at discharge which they defined as unnecessary antibiotic use, excess antibiotic duration, or suboptimal fluoroquinolone use.
More than half of patients treated for pneumonia had antibiotic overuse, as did more than a third of patients treated for UTI.
For patients with pneumonia, about two-thirds of the overuse was related to excess duration of treatment. For patients with UTI, just under half of the overuse was due to treatment of asymptomatic bacteriuria.
This study highlights a potential area of focus for antibiotic stewardship. However, before focusing your antibiotic stewardship program on this area, it would be wise to spot-check your institution’s rate of antibiotic overuse at discharge for pneumonia and UTI. The authors of this study found a wide variation between the 46 sites with the best performing hospital having only a 15.9% rate of overuse on discharge and the worst performing having more than 5 times that at 80.6%.
Members of my Hospital Pharmacy Academy have access to in-depth practical training from a pharmacist’s point of view on antibiotic stewardship topics such as Approach to Antibiotic De-Escalation in Patients with Sepsis, Approach to Antibiotic De-Escalation in Patients with Pneumonia, Alternative Antibiotics to Reduce the Use of Quinolones, Pharmacist’s Role in Preventing C. diff Infection in the ICU, and Prospective Audit with Feedback. This is in addition to many other practical trainings and resources for hospital pharmacists. To browse the title and objectives of each training, follow the links at pharmacyjoe.com/training. To get immediate access to these and other resources to help in your practice, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Hi pharmacy Joe thanks for great post if I could piggyback onto your important message – there’s a huge role for pharmacists looking at drug interactions of the macrolides or Quinolones if pt is on anti arrhythmics and also tizanidine cipro category x interaction… point being keep an eye on the discharge antibiotic and potential home meds or other meds that may interact significantly thanks again
Joe Dougherty PharmD