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Impact of a Formulary Change and Implementation of a Legacy Medication Alternative in the Electronic Medical Record
Hailey Kemp1, Kalen B Manasco2,3
1Department of Pharmacy (HK), University of Florida Health Shands Hospital, Gainesville, FL.
Insights
A formulary change did not significantly decrease cefdinir prescribing for pediatric patients. However, the intervention led to shorter hospital stays and fewer re-encounters, suggesting improved antibiotic stewardship outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Health Services Research
Background:
- Oral cephalosporins are commonly used for de-escalation of antibiotic therapy in pediatric patients.
- Cefdinir prescribing patterns can impact antimicrobial stewardship efforts.
- Electronic medical record interventions aim to optimize antibiotic selection.
Purpose of the Study:
- To evaluate the impact of an oral cephalosporin formulary change and electronic medical record intervention on cefdinir prescribing.
- To assess changes in optimal enteral antibiotic de-escalation rates in pediatric patients.
- To determine the effect of the intervention on hospital length of stay and re-encounter rates.
Main Methods:
- Retrospective cohort study comparing pediatric patients before and after a formulary change and EMR intervention.
- Inclusion criteria: hospitalized pediatric patients receiving ceftriaxone de-escalated to an enteral antibiotic.
- Primary outcome: change in cefdinir prescribing; secondary outcomes: optimal de-escalation, length of stay, re-encounters.
Main Results:
- Cefdinir prescribing decreased from 44% to 34% but was not statistically significant (p=0.287).
- Optimal enteral antibiotic de-escalation rates increased from 62% to 72% (p=0.245).
- Hospital re-encounters significantly decreased (8% to 0%, p=0.035) and length of stay was reduced (p=0.038).
Conclusions:
- The formulary change and EMR intervention did not significantly reduce cefdinir use or improve optimal de-escalation rates.
- Significant reductions in hospital re-encounters and length of stay were observed post-intervention.
- Further research is needed to validate these positive clinical outcomes.
Objective:
To assess prescribing patterns following an oral cephalosporin formulary change and the implementation of a legacy medication alternative in the electronic medical record to discourage prescribing cefdinir when de-escalating intravenous ceftriaxone to an enteral antibiotic in pediatric patients.
Methods:
This was a single-center, retrospective cohort study of hospitalized pediatric patients who received at least 1 dose of ceftriaxone de-escalated to an enteral antibiotic for the treatment of community-acquired pneumonia, upper respiratory tract infection, or urinary tract infection. Patients from a 6-month period post-formulary change were compared with a historical cohort from the same timeframe, 1 year prior. The primary outcome was the change in cefdinir prescribing. Secondary outcomes included the rate of optimal antibiotic de-escalation before and after the interventions, hospital length of stay, and hospital re-encounter rates.
Results:
A total of 134 patients were included. Cefdinir prescribing occurred in 44% and 34% (p = 0.287) of patients pre- and post-intervention, respectively. Optimal enteral antibiotic de-escalation occurred in 46 (62%) patients pre-intervention and 43 (72%) post-intervention (p = 0.245). Rates of optimal de-escalation were lowest for patients treated for urinary tract infection (< 60% in both cohorts), with cefdinir used in 48% of these cases. Hospital re-encounters occurred in 6 (8%) patients pre-intervention and 0 (0%) post-intervention (p = 0.035). Median length of stay was significantly reduced (p = 0.038) post-intervention, driven by a 1-day reduction in patients treated for community-acquired pneumonia (p = 0.013).
Conclusions:
After the formulary changes involving cefdinir, there was no significant decrease in cefdinir use or in optimal de-escalation rates. There were significantly lower hospital re-encounters and shorter lengths of stay, though further studies are needed to validate these findings.
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