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Published on: August 30, 2018
Evaluation and implementation of optimized antimicrobial dosing strategies in obese and underweight patients
Valerie Caubergs1, Evelyne Van den Broucke2,3, Beatrijs Mertens1,4
1Pharmacy Department, UZ Leuven, 3000, Leuven, Belgium.
Insights
Developing specific antimicrobial dosing guidelines for obese and underweight patients significantly reduced inappropriate antibiotic prescriptions in a hospital setting. This intervention improved patient care by ensuring correct medication use.
Area of Science:
- Pharmacology
- Infectious Diseases
- Hospital Pharmacy
Background:
- Obese and underweight patients often require adjusted antimicrobial dosing.
- Standard dosing regimens may lead to suboptimal drug exposure in these populations.
- Lack of specific dosing guidelines complicates antimicrobial prescribing for atypical weight patients.
Purpose of the Study:
- To develop and implement antimicrobial dosing recommendations for obese and underweight patients.
- To evaluate the impact of these recommendations on antibiotic prescribing practices.
- To reduce potentially inappropriate prescriptions (PIPs) in these patient groups.
Main Methods:
- A multi-step approach including a point prevalence study, literature review, and expert e-survey.
- Development of six clinical rules for continuous screening of patient records.
- Implementation in a clinical validation service with uptake and acceptance rate evaluation.
- Interrupted time series analysis to compare pre- and post-implementation periods.
Main Results:
- 41% of hospitalized patients received antimicrobials; 12% were obese and 9% underweight.
- Six dosing recommendations were developed and implemented.
- Clinical rules led to 219 advices with an 86% acceptance rate.
- An 84% relative reduction in residual potentially inappropriate prescriptions (PIPs) per day was observed post-implementation.
Conclusions:
- Evidence-based dosing recommendations for obese and underweight patients were successfully developed.
- Implementation of clinical rules significantly reduced inappropriate antimicrobial prescribing.
- The intervention effectively addressed the specific needs of these patient populations in an academic hospital.
Purpose:
We aimed to develop and implement dosing recommendations for antimicrobials in obese and underweight patients within an academic hospital, and assess their impact on antibiotic prescribing.
Methods:
A multi-step approach project was performed. First, obese and underweight patient prevalence and antimicrobial prescription frequency was determined in a point prevalence study. Second and third, a literature review and e-survey provided dosing evidence. Fourth, a consensus meeting was organized to formulate dosing recommendations. Fifth, these were implemented in our clinical validation service as six clinical rules continuously screening patients' records for potentially inappropriate prescriptions (PIPs). Uptake was evaluated by documenting the number of advices and acceptance rate. Last, an interrupted time series analysis (ITS) compared pre- and post-implementation periods to measure the impact of the intervention on residual PIPs/day. A residual PIP was defined as a PIP which persisted up to 48 h.
Results:
First, 41% of 15.896 hospitalized patients received antimicrobials over 20 days; of which 12% were obese and 9% underweight. Antibiotics were predominantly prescribed according to standard dosing regimens, adjusted to renal function. Next, six dosing recommendations, derived from literature, survey, and consensus, were implemented. In the fifth step, during an 18-week period, 219 advices were given, with 86% acceptance rate. Last, in the ITS analysis, at preintervention, a median of 75% residual PIPs/day existed, reduced to 0% postintervention. Use of clinical rules resulted in a significant immediate 84% relative reduction in residual PIPs (95% CI 0.55-0.94).
Conclusion:
After conducting a literature review, e-survey, and seeking consensus from a panel of experts, dosing recommendations for antimicrobial treatment in both obese and underweight patients were developed. These recommendations have been successfully implemented into clinical practice, addressing the specific needs of these patient populations.
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