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Alternative ASP model significantly reduces pediatric antibiotic use
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Recent findings published in Pediatrics showed that an alternative antibiotic stewardship program that shares responsibilities between ID physicians and pharmacists at Children’s Hospital of Pittsburgh significantly reduced antibiotic use.
“I don’t know that our model is necessarily better than the ‘standard’ model as described in the IDSA guidelines on starting an ASP, but I think what our study shows is that different models can be equally effective,” Michael Green, MD, MPH, of the departments of surgery and pediatrics at the University of Pittsburgh School of Medicine, told Infectious Diseases in Children. “Each of the different models may have potential strengths and weaknesses.”
In 2007, the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America collectively published guidelines for the first antimicrobial stewardship program (ASP), the researchers wrote. In 2008, Children’s Hospital of Pittsburgh created an alternative ASP, featuring shared responsibilities between ID physicians and service-based clinical pharmacists. The hospital also used electronic medical records to facilitate ongoing evaluations of the ASP.
This ASP model combined strategies of education, antimicrobial restriction, day 3 audits and practice guidelines. High-use and high-cost antibiotics were chosen with audits that targeted vancomycin, caspofungin and meropenem. The researchers used electronic medical records to identify patients who required day 3 audits and to communicate the ASP regulations. Quarterly antibiotic prescription data was assessed through segmented regression analyses.
Initiation of the ASP and day 3 auditing were associated with decreased usage of caspofungin (12%), vancomycin (25%) and meropenem (31%), with the greatest declines seen in critical care. In a 3-month review of acceptance of the ASP, 90% of vancomycin-use recommendations were accepted, as well as 93% for caspofungin, and 100% for meropenem.
While service-based pharmacist use allowed the ASP to be cost-effective, it may have limited the effectiveness of the program, Green said.
“If you have ‘dedicated’ pharmacists for your ASP, you are more likely to continue to expand the range and impact of your ASP program,” Green said. “If you use pre-existing service-based pharmacists for your ASP, they have a lot of pre-existing responsibilities that they must continue to do in addition to the work that they do on behalf of their antimicrobial stewardship programs.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
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