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An antimicrobial stewardship program improves appropriate antimicrobial use among hospitalized children

Half of all antimicrobial therapy prescribed for hospitalized patients is inappropriate, which can lead to longer hospital stays, higher medical costs, and higher mortality rates. Use of an Antimicrobial Stewardship Program (ASP), in which an infectious disease consultant controls use of antimicrobials (antibiotics, antifungals, and antivirals) by hospital staff, can improve the appropriate use of antimicrobials concludes a new study.

A team from Children's Hospital of Philadelphia retrospectively reviewed charts of children hospitalized at the hospital for whom clinicians requested antimicrobials. They examined the clinicians' requests and the interventions made by the ASP, as well as children's outcomes. The ASP oversaw the use of targeted antimicrobial agents ranging from acyclovir and amikacin to broad-spectrum cephalosporins, ribavirin, and vancomycin. Physicians were prompted by the computerized physician order entry system to contact the ASP for each targeted agent.

During the 4-month study period, clinicians placed 652 calls to the ASP. The most frequently requested targeted agents were vancomycin (30 percent), cefotaxime (11 percent), ceftazidime (11 percent), and ampicillin/sulbactam (9 percent) for problems ranging from suspected bloodstream infection to community-acquired pneumonia. Nearly half (45 percent) of the calls required an intervention by the ASP. Specifically, the ASP intervened to resolve drug-bug mismatches (antibiotic was not providing adequate coverage or too broad coverage for the susceptibility pattern of the identified pathogen), to minimize the unnecessary use of broad-spectrum antibiotics, to reduce duplicate therapy, to reduce duration of therapy, and to improve dosing. It was also often used as a resource by clinicians seeking information on appropriate antimicrobial use.

The ASP made recommendations that ultimately avoided potentially unsafe patient conditions. The study was supported in part by the Agency for Healthcare Research and Quality (HS10399).

See "Evaluation of an antimicrobial stewardship program at a pediatric teaching hospital," by Talene A. Metjian, Pharm.D., Priya A. Prasad, M.P.H., Amy Kogon, M.D., and others, in the February 2008 Pediatric Infectious Disease Journal 27(2), pp. 106-111.

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