Does a Pharmacist-Driven Protocol Increase Appropriate Prescribing of Rabies Postexposure Prophylaxis?

Area of Science:

• Emergency Medicine
• Infectious Disease Prevention
• Pharmacoeconomics

Background:

• Human rabies is preventable with postexposure prophylaxis (PEP), but its incidence is low in the US.
• Despite low incidence, rabies diagnostics and prevention incur significant costs.
• Studies indicate frequent unnecessary prescribing of PEP, highlighting a need for improved adherence to guidelines.

Purpose of the Study:

• To evaluate if an animal bite protocol enhances compliance with rabies postexposure prophylaxis (PEP) recommendations in emergency departments (ED).
• To assess the potential cost savings associated with implementing an animal bite protocol.

Main Methods:

• A single-center, retrospective chart review analyzed patients presenting to the ED with animal bites before and after protocol implementation.
• The primary outcome measured was the percentage of PEP offered according to the protocol.
• Secondary outcomes included the appropriateness of PEP decisions and estimated cost savings.

Main Results:

• PEP was appropriately offered less frequently post-protocol (3/5) compared to pre-protocol (4/29), indicating improved adherence (p=0.0476).
• There was no significant difference in the appropriateness of withholding PEP (pre-protocol 105/107 vs. post-protocol 29/29; p=0.9998).
• Protocol implementation was associated with cost savings.

Conclusions:

• A pharmacist-driven protocol effectively influences prescribing practices for potential rabies exposures.
• Implementing such protocols can lead to cost savings while improving adherence to evidence-based guidelines.