A randomized trial to measure the optimal role of the pharmacist in promoting evidence-based antibiotic use in acute care hospitals

Background: There is a considerable gap between randomized clinical trials and implementing the results into practice. This is particularly relevant i n the use of broad-spectrum antibiotics in hospitals. Hospital pharmacists can be effective vehicles for bridging this gap and promoting evidence-base d medicine. To determine the most effective way of using the pharmacist in this role, a prospective cefotaxime intervention study was conducted with r andomization incorporated into the design as well as patient-related therap eutic outcomes. Methods: A total of 323 patients who were prescribed cefotaxime were random ized into an intervention or nonintervention group where only the former wa s challenged by pharmacists for inappropriate cefotaxime usage relative to hospital guidelines. The primary outcome was the appropriateness of cefotax ime prescribing between groups. Logistic regression analysis was then used to identify factors that were associated with successful clinical response. Results: Overall, 94% of orders in the intervention group met cefotaxime do sage criteria compared with 86% in the control group (p = .018). However, t here was no impact with respect to promoting cefotaxime use for an appropri ate indication (81% vs. 80%; p = .67). There was a trend for improved clini cal outcomes in patients who received cefotaxime within hospital guidelines (OR = 1.73; p = .31). Conclusions: The pharmacist as a vehicle for promoting the appropriate use of broad-spectrum antibiotics in the acute care hospital setting can improv e the dosing of such agents. However, several barriers to optimizing the im pact of the pharmacist were implied by the data. Removing these barriers co uld increase the pharmacists' utility as an agent for improved patient care .