Antibiotic Optimization: An Evaluation of Patient Safety and Economic Outcomes

doi:10.1001/archinte.1997.00440360105012

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Vol. 157 No. 15, 11 AUGUST 1997

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Antibiotic Optimization

An Evaluation of Patient Safety and Economic Outcomes

Gilles L. Fraser, PharmD; Patricia Stogsdill, MD; John D. Dickens, Jr; David E. Wennberg, MPH, MD; Robert P. Smith, Jr, MD; B. Stephen Prato, MA

Arch Intern Med. 1997;157(15):1689-1694.

Abstract

Background
Although numerous reports have described interventions designedto influence antibiotic utilization, to our knowledge none havebeen evaluated in a randomized study.

Methods
Adult inpatients receiving 1 or more of 10 designated parenteralantibiotics for 3 or more days during a 3-month period wererandomized to an intervention (n=141) and a control (n=111)group using an unblocked, computer-generated random number table.Obstetric patients and those seen in infectious disease consultationwere excluded. The intervention group received antibiotic-relatedsuggestions from a team consisting of an infectious diseasefellow and a clinical pharmacist. Both groups were evaluatedfor clinical and microbiological outcomes as well as antibioticutilization via prospective chart reviews and analysis of thehospital's administrative database.

Results
Sixty-two (49%) of the intervention group patients receiveda total of 74 suggestions. Sixty-three (84%) of these suggestionswere implemented; the majority involved changes in antibioticchoice, dosing regimen, or route of administration. Per patientantibiotic charges were nearly $400 less in the interventiongroup vs controls (P=.05). Almost all the savings were relatedto lower intravenous antibiotic charges. Clinical and microbiologicalresponse, antibiotic-associated toxic effects, in-hospital mortality,and readmission rates were similar for both groups. Multiplelinear regression analysis identified randomization to the interventiongroup and female sex as the sole predictors of lower antibioticcharges. There was a trend toward a shorter length of stay forthe intervention group (20 vs 24.7 days, P=.11).

Conclusions
This is the first randomized study to evaluate whether antibioticchoices can be influenced in a cost-effective fashion withoutsacrificing patient safety. We demonstrate that 50% of patientsinitially treated with expensive parenteral antibiotics canhave their regimens refined after 3 days of therapy and thatthese modifications result in good clinical outcomes with asubstantial reduction in antibiotic expense.

Arch Intern Med. 1997;157:1689-1694

Author Affiliations

From the University of Vermont College of Medicine, Burlington (Drs Fraser, Stogsdill, and Smith), and Critical Care Medicine (Dr Fraser and Mr Prato), Infectious Disease Division (Drs Stogsdill and Smith), and Division of Health Services Research (Mr Dickens and Dr Wennberg), Maine Medical Center, Portland.

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