ANTIBIOTIC OPTIMIZATION - AN EVALUATION OF PATIENT SAFETY AND ECONOMIC OUTCOMES

Background: Although numerous reports have described interventions des igned to influence antibiotic utilization, to our knowledge none have been evaluated in a randomized study. Methods: Adult inpatients receiv ing 1 or more of 10 designated parenteral antibiotics for 3 or more da ys during a 3-month period were randomized to an intervention (n=141) and a control (n=111) group using an unblocked, computer-generated ran dom number table. Obstetric patients and those seen in infectious dise ase consultation were excluded. The intervention group received antibi otic-related suggestions from a team consisting of an infectious disea se fellow and a clinical pharmacist. Both groups were evaluated for cl inical and microbiological outcomes as well as antibiotic utilization via prospective chart reviews and analysis of the hospital's administr ative database. Results: Sixty-two (49%) of the intervention group pat ients received a total of 74 suggestions. Sixty-three (84%) of these s uggestions were implemented; the majority involved changes in antibiot ic choice, dosing regimen, or route of administration. Per patient ant ibiotic charges were nearly $400 less in the intervention group vs con trols (P=.05). Almost all the savings were related to lower intravenou s antibiotic charges. Clinical and microbiological response, antibioti c-associated toxic effects, in-hospital mortality, and readmission rat es were similar for both groups. Multiple linear regression analysis i dentified randomization to the intervention group and female sex as th e sole predictors of lower antibiotic charges. There was a trend towar d a shorter length of stay for the intervention group (20 vs 24.7 days , P=.11). Conclusions: This is the first randomized study to evaluate whether antibiotic choices can be influenced in a cost-effective fashi on without sacrificing patient safety. We demonstrate that 50% of pati ents initially treated with expensive parenteral antibiotics can have their regimens refined after 3 days of therapy and that these modifica tions result in good clinical outcomes with a substantial reduction in antibiotic expense.