Monitoring Antibiotic Consumption in Pediatrics. How Close to Reality Are Days of Therapy and Recommended Daily Dose Methods?

Objective.To determine whether controlling the prescription of targeted antibiotics would translate to a measurable reduction in hospital-onset Clostridium difficile infection (CDI) rates.Design.A multicenter before-and-after intervention comparative study.Setting/Participants.Ten medical centers in the greater New York region. Intervention group comprised of 6 facilities with early antimicrobial stewardship programs (ASPs). The 4 facilities without ASPs made up the nonintervention group.Interventions/Methods.Intervention facilities identified target antibiotics using case-control studies and implemented ASP-based strategies to control their use. Pre- and postintervention hospital-onset CDI rates and antibiotic consumption were compared for a 20-month period from June 2010 to January 2012. Antibiotic usage was compared using defined daily dose, days of therapy, and number of courses prescribed. Comparisons used bivariate and regression techniques.Results.Intervention facilities identified piperacillin/tazobactam, fluoroquinolones, or cefepime (odds ratio, 2.0-9.8 in CDI case patients compared with those without CDI) as intervention targets and selected several interventions (all included a component of audit and feedback). Varying degrees of success were observed in reducing antibiotic consumption over time. Total target antibiotic use significantly decreased (P < .05) when measured by days of therapy and number of courses but not by defined daily dose. Intravenous moxifloxacin and oral ciprofloxacin use showed significant reduction when measured by defined daily dose and days of therapy (P ≤ .01). Number of courses with all forms of these antibiotics was reduced (P ≤ .005). Intervention hospitals reported fewer hospital-onset CDI cases (2.8 rate point difference) compared with nonintervention hospitals; however, we were unable to show statistically significant decreases in aggregate hospital-onset CDI either between intervention and nonintervention groups or within the intervention group over time.Conclusions.Although decreases in target antibiotic consumption did not translate into reductions of hospital-onset CDI in this study, many valuable lessons (including implementation strategies and antibiotic consumption measures) were learned. The findings can inform potential policy decisions regarding incorporating control of CDI and ASP as healthcare quality measures.

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Measuring antibiotic consumption and outcomes

10.1093/med/9780198758792.003.0006 ◽

2016 ◽

Author(s):

Hayley Wickens

Keyword(s):

Antimicrobial Stewardship ◽

Antibiotic Consumption ◽

Electronic Prescribing ◽

Defined Daily Dose ◽

Antimicrobial Usage ◽

Monitoring Process ◽

Days Of Therapy ◽

Daily Dose ◽

Information Management Systems ◽

The Uk

Understanding how antimicrobial usage is monitored and reported is crucial when reading the literature on antimicrobial stewardship and assessing outcomes of local programmes. This chapter covers the methods used to monitor antimicrobial usage and the associated terminology, such as defined daily dose (DDD), average daily quantities (ADQs), and days of therapy (DOT), and gives and overview of usage monitoring in primary and secondary healthcare in the UK and beyond. This chapter also covers potential roles for electronic prescribing and information management systems in the monitoring of antimicrobial usage, and highlights some issues in the monitoring process and the outcome of antimicrobial stewardship initiatives.

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1662. Pushing the Dose: Miltefosine Treatment for a Supersized American with Cutaneous Leishmaniasis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1526 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S608-S608

Author(s):

Naomi E Aronson ◽

Ignace Roseboom ◽

Michael Digby ◽

Christina Bravos ◽

Daniel Selig ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Complete Blood Count ◽

Plasma Concentrations ◽

Treatment Regimens ◽

Unsuccessful Treatment ◽

Days Of Therapy ◽

Daily Dose ◽

Fatty Food ◽

Ulcerative Lesions ◽

Apparent Distribution

Abstract Background Miltefosine (Profounda, FL) is an oral alkylphospholipid drug which is approved by the Food and Drug Administration for the treatment of some species of New World cutaneous leishmaniasis. The maximal daily recommended dosage is 50 mg t.i.d for 28 days; yet there is some evidence that doses <2.5 mg/kg/day may be associated with lesser efficacy. We treated a healthy 30-year-old, 117 kg, 78 inches (low body fat) male with cutaneous Leishmania tropica infection with miltefosine after multiple unsuccessful treatment regimens. This presentation will provide the background considerations and the outcome of our approach of using higher daily dosages of miltefosine. Methods We used a miltefosine dose escalation of 50 mg t.i.d (1.28 mg/kg/day) for days 1–5 with fatty food, increasing to 50 mg. q.i.d. (1.71 mg/kg/day) for days 6–15. For days 16–28, the patient received 250 mg daily (2.13 mg/kg/day). Weekly blood testing was done for complete blood count, metabolic panel, and miltefosine pharmacokinetics. Plasma concentrations were assayed using a validated liquid chromatography coupled to tandem mass spectrometry methodology. Results The patient experienced a good clinical result with his two ulcerative lesions on the left leg healing with full epithelialization by day 28. He tolerated miltefosine well until he escalated to 250 mg daily when he noted 2 hours of fatigue and dizziness after the dose, nausea and after the fourth day he developed epididymitis. His serum creatinine was elevated (1.4 mg/dL). The epididymitis resolved after approximately a week, his other symptoms resolved soon after completing the day 28 dose. Serial miltefosine plasma levels accumulated during treatment to 30, 34, 44, and 53 μg/mL on days 7, 14, 21, and 27 after the start of treatment (dropping to 27 μg/mL 8 days post), with an apparent distribution half-life of 7 days. Conclusion Miltefosine yielded healing of recalcitrant L. tropica infection but was associated with adverse effects at the 250 mg daily dose that severely limited the activity of the patient for the final 8 days of therapy; however, they were not dose-limiting. Miltefosine accumulation appeared to be dose-proportional compared with reported concentrations with a median 1.8 mg/kg/day dose in Dutch cutaneous leishmaniasis patients (median weight 85 kg). Disclosures All authors: No reported disclosures.

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1119. Implementation of Pediatric Antimicrobial Stewardship Rounds in a Children’s Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.983 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S397-S398

Author(s):

Natalie Tucker ◽

Ezzeldin Saleh ◽

Marcela Rodriguez

Keyword(s):

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Antibiotic Prescribing ◽

Successful Implementation ◽

Custom Made ◽

Days Of Therapy ◽

Before And After ◽

The Individual

Abstract Background Antimicrobial stewardship programs (ASP) are required in all acute care hospitals per The Joint Commission. ASP must adhere to the recommendations laid out by the Centers for Disease Control and Prevention, but how each ASP chooses to implement these recommendations is left to the individual program. In January 2018, we began formal antimicrobial stewardship (AMS) walking rounds, led by infectious diseases trained physician and pharmacist, in our 99-bed pediatric hospital. Methods In January 2018, we started twice-weekly AMS rounds on the pediatric hospitalist service. A custom-made “Antimicrobial Stewardship Patient List” was designed in our electronic medical record (EMR) to generate a list of all patients receiving antibiotics. The ASP team (comprised of an infectious diseases pharmacist and a pediatric infectious diseases physician) reviewed EMR charts to determine antibiotic prescribing appropriateness and design recommended interventions. Any recommendations and teaching points were then discussed with the hospitalist team in person. After piloting the hospitalist service, AMS rounds were extended to include the general surgery patients and finally the intensive care unit. Data on number of charts reviewed, proposed interventions, and acceptance rates were collected throughout the process. Descriptive statistics were used to assess the intervention data. Results In the first year of the program, 427 patient charts were reviewed with 186 identified interventions. In total, 156 (84.3%) of the interventions were accepted and implemented by the primary team. The most common types of interventions were the duration of therapy (29%), antibiotic discontinuation (16.7%), intravenous to oral conversion (11.3%), de-escalation (10.2%), and infectious diseases consult (5.9%). Conclusion Pediatric AMS rounds led to the successful implementation of the majority of recommended interventions. Future goals of the program include calculating days of therapy per 1000 patient-days to assess antibiotic consumption before and after AMS rounds and to expand into other services to further promote appropriate antibiotic use in hospitalized pediatric patients. Disclosures All authors: No reported disclosures.

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Evaluation of Antimicrobial Consumption Using Days of Therapy With Defined Daily Dose

Japanese Journal of Infection Prevention and Control ◽

10.4058/jsei.29.333 ◽

2014 ◽

Vol 29 (5) ◽

pp. 333-339 ◽

Cited By ~ 2

Author(s):

Takashi NIWA ◽

Yuki TONOGAI ◽

Keiko SUZUKI ◽

Tamayo WATANABE ◽

Mayumi TSUCHIYA ◽

...

Keyword(s):

Defined Daily Dose ◽

Antimicrobial Consumption ◽

Days Of Therapy ◽

Daily Dose

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In reply to: “Antimicrobial defined daily dose adjusted by weight: A proposal for antibiotic consumption measurement in children”

Enfermedades infecciosas y microbiologia clinica (English ed ) ◽

10.1016/j.eimce.2019.01.004 ◽

2019 ◽

Vol 37 (5) ◽

pp. 357-358

Author(s):

Walter-Alfredo Goycochea-Valdivia ◽

Elena Montecatine-Alonso ◽

María-Victoria Gil-Navarro ◽

Olaf Neth

Keyword(s):

Antibiotic Consumption ◽

Defined Daily Dose ◽

Daily Dose

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Development of Tolerance to Chronic Intermittent Furosemide Therapy in Pediatric Patients

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-22.6.394 ◽

2017 ◽

Vol 22 (6) ◽

pp. 394-398

Author(s):

Gloria J. Kim ◽

Edmund Capparelli ◽

Gale Romanowski ◽

James A. Proudfoot ◽

Adriana H. Tremoulet

Keyword(s):

Fluid Balance ◽

Pediatric Patients ◽

Daily Intake ◽

Total Daily Dose ◽

Day Range ◽

Age Related ◽

Days Of Therapy ◽

Daily Dose ◽

The Difference ◽

Development Of Tolerance

OBJECTIVES The purpose of this study is to describe whether tolerance develops in pediatric patients receiving chronic intermittent furosemide therapy, to characterize when it occurs and whether age-related variations exist. The effects of increasing total daily dose of furosemide and concurrent diuretics and vasopressors were assessed as secondary aims. METHODS Charts from patients receiving intravenous or oral furosemide for at least 3 consecutive days of therapy between June 1, 2013, and December 31, 2013, were reviewed retrospectively. Daily net fluid balance was used as the objective marker for development of tolerance. Net fluid balance (mL/kg/mg) was defined as the difference in a patient's daily intake and urine output (mL), normalized by weight (kg) and total daily dose of furosemide (mg). RESULTS Sixty-one patients, aged 2 days to 20 years (median 3 years), were included in this study. Median daily dose of furosemide was 1.96 mg/kg/day (range, 0–13.7 mg/kg/day). Average net fluid balance for all patients on the first day and last day of therapy was 6.83 and 26.66 mL/kg/mg, respectively (p = 0.011). Linear regression and Spearman's correlation found no significant relationship between age and difference in net fluid balance between the first and last day. Linear mixed-effects model for net fluid balance with day as covariate found that net fluid balance increases over time (p = 0.002). CONCLUSIONS Pediatric patients appear to develop tolerance to chronic intermittent furosemide therapy.

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Impact of a pharmacist-driven antimicrobial stewardship program in a private hospital in Costa Rica

Revista Panamericana de Salud Pública ◽

10.26633/rpsp.2020.57 ◽

2020 ◽

Vol 44 ◽

pp. 1

Author(s):

José Pablo Díaz-Madriz ◽

Eugenia Cordero-García ◽

José Miguel Chaverri-Fernández ◽

Esteban Zavaleta-Monestel ◽

Josué Murillo-Cubero ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Private Hospital ◽

Bacterial Resistance ◽

Defined Daily Dose ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Days Of Therapy ◽

Daily Dose ◽

Resistance Patterns ◽

The Impact

Objective. To measure the impact generated by the implementation of the pharmacy-driven antimicrobial stewardship program of the Clínica Bíblica Hospital. Methods. This is a retrospective observational study that evaluates the consumption of antibiotics for the periods before and during implementation of the Clínica Bíblica Hospital antimicrobial stewardship program, calculated by means of defined daily dose per 1 000 patient-days and days of therapy per 1 000 patient-days. In addition, bacterial resistance patterns for the periods 2014–2015 and 2016–2017 were compared. Results. Consumption of most-used antibiotics was calculated, looking for trends that might be associated with the activities implemented by the Clínica Bíblica Hospital antimicrobial stewardship program. Comparing some of the antibiotics with the highest consumption in periods I and II, use of levofloxacin and ceftriaxone showed a decrease of 54.0% (p < 0.001) and 14.6% (p = 0.003), respectively, whereas there was an increase in the use of cefazolin of 4 539.3% (p < 0.001). Regarding percentage of bacterial resistance, in most bacterial isolates no statistically significant changes were observed between the two periods. Conclusions. A reduction in the overall consumption of antibiotics has been achieved over time, most likely attributable to the antimicrobial stewardship program. However, this trend was not observed for all the antibiotics studied. The pattern of resistance among the commonly isolated microorganisms did not vary greatly between the periods studied, which suggests that either the antimicrobial stewardship program may have prevented an increase in bacterial resistance since its implementation, or that it is too soon to see impact on bacterial resistance.

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Analysis of antibiotic consumption for treating respiratory tract infections in children and compliance with the national clinical guidelines

Medicinski pregled ◽

10.2298/mpns1410282l ◽

2014 ◽

Vol 67 (9-10) ◽

pp. 282-289 ◽

Cited By ~ 3

Author(s):

Dragana Lakic ◽

Ivana Tadic ◽

Marina Odalovic ◽

Ljiljana Tasic ◽

Ana Sabo ◽

...

Keyword(s):

Respiratory Tract ◽

Respiratory Tract Infections ◽

Respiratory Infections ◽

Acute Otitis Media ◽

Antibiotic Consumption ◽

Defined Daily Dose ◽

Upper Respiratory Tract ◽

National Guidelines ◽

Daily Dose ◽

Tract Infections

Introduction. Respiratory infections are the most common infections in children. The aims of the study were to analyze the use of antibiotics for respiratory infections in the period 2008 - 2010 in children?s population in region of Nis and to estimate the rational use of antibiotics in relation to the recommendations of the National Guidelines for physicians in primary care. Material and methods. Data source was a Pharmacy Nis database. Antibiotics prescriptions were selected for the following diagnoses: H65-H75 (acute otitis media, mastoiditis), J01 (acute sinusitis), J02-J03 (tonsillopharyngitis), J12-J18 (community acquired pneumonia), J20 (acute bronchitis), J32 (chronic sinusitis), J42 (chronic bronchitis). Antibiotic consumption was expressed in defined daily dose/1000 inhabitants/day. Results. The most widely prescribed antibiotic for the treatment of upper respiratory tract infections in children during the three years was amoxicillin (34.63; 32.50 and 31.00 defined daily dose/1000 inhabitants/day in 2008, 2009 and 2010, respectively). In the treatment of infections of the middle ear and mastoid, the combination of amoxicillin and clavulanic acid, was the most prescribed antibiotics (60% of total consumption of antibiotics for this indication). Azithromycin was the most widely prescribed antibiotic for the treatment of lower respiratory tract infections in children during the observed period (6.92; 8.20 and 7.18 defined daily dose/1000 inhabitans/day in 2008, 2009 and 2010, respectively). Conclusion. Recommendations of national guidelines are not complied with the treatment of upper and lower respiratory infections in the children population in region of Nis. This could be a sign of potentially irrational use of antibiotics that need to be further examined. Education of physicians can influence irrational use of antibiotics.

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