Publication:
A noninferiority cluster-randomized controlled trial on antibiotic postprescription review and authorization by trained general pharmacists and infectious disease clinical fellows

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Issued Date

2018

Resource Type

Review

File Type

application/pdf

ISSN

0899823X

DOI

10.1017/ice.2018.198

Other identifier(s)

2-s2.0-85053002289

Rights Holder(s)

Scopus

Bibliographic Citation

Infection Control and Hospital Epidemiology. Vol 39, No.10 (2018), p.1154-1162

Suggested Citation

Rattanaumpawan P., Upapan P., Thamlikitkul V. A noninferiority cluster-randomized controlled trial on antibiotic postprescription review and authorization by trained general pharmacists and infectious disease clinical fellows. Infection Control and Hospital Epidemiology. Vol 39, No.10 (2018), p.1154-1162. doi:10.1017/ice.2018.198 Retrieved from: https://hdl.handle.net/20.500.14740/5835

Title

A noninferiority cluster-randomized controlled trial on antibiotic postprescription review and authorization by trained general pharmacists and infectious disease clinical fellows

Author(s)

Rattanaumpawan P.
 Upapan P.
 Thamlikitkul V.

Abstract

Objective We compared the effectiveness of antibiotic postprescription review and authorization (PPRA) determined by infectious disease (ID) clinical fellows with that of trained general pharmacists.Methods We conducted a noninferiority cluster-randomized controlled trial in 6 general medical wards at Siriraj Hospital in Bangkok, Thailand. Three wards were randomly assigned to the intervention (ie, the pharmacist PPRA group), and another 3 wards were assigned to the control (ie, the fellow PPRA group). We enrolled all patients in the study wards who received 1 or more doses of the targeted antibiotics: piperacillin/tazobactam, imipenem/cilastatin, and meropenem. The noninferiority margin was 10% for the favorable clinical response and 1.5 defined daily doses (DDDs) for the targeted antibiotics.Results We enrolled 303 patients in the pharmacist PPRA group and 307 patients in the ID fellow PPRA group. The baseline and clinical characteristics were similar in the 2 groups. The difference in the favorable response of patients who received the targeted antibiotics (ie, the pharmacist PPRA group minus the fellow PPRA group) was 5.15% (95% confidence interval [CI], -2.69% to 12.98%); the difference in the DDD of targeted antibiotic use (ie, the pharmacist PPRA group minus the fellow PPRA group) was 0.62 (95% CI, -1.57 to 2.82). We observed no significant difference in the DDD of overall antibiotics, 28-day mortality, 28-day ID-related mortality, favorable microbiological outcome, or antibiotic-associated complications.Conclusions We confirmed the noninferiority of pharmacist PPRA in terms of favorable clinical response; however, noninferiority in targeted antibiotic consumption could not be established. Therefore, using trained general pharmacists rather than ID clinical fellows could be an alternative in a resource-limited setting. Clinical trials registration: clinicaltrials.gov identifier: NCT 01797133 © 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.

Subject(s)

Cilastatin plus imipenem
 Meropenem
 Piperacillin plus tazobactam
 Prescription drug
 Antiinfective agent
 Adult
 Antibiotic associated colitis
 Antibiotic postprescription review and authorization
 Antibiotic prophylaxis
 Antibiotic therapy
 Antimicrobial stewardship
 Bone infection
 Cardiovascular infection
 Catheter infection
 Central nervous system infection
 Clinical outcome
 Colitis
 Community acquired infection
 Comparative effectiveness
 Controlled study
 Drug cost
 Drug hypersensitivity
 Drug induced disease
 Drug response
 Drug use
 Drug utilization review
 Female
 Gastrointestinal infection
 Genital tract infection
 Head and neck infection
 Hospital infection
 Hospital mortality
 Hospital patient
 Human
 Infectious arthritis
 Infectious disease clinical fellow
 Intervention study
 Length of stay
 Major clinical study
 Male
 Medical education
 Middle aged
 Multicenter study
 Nose infection
 Pharmacist
 Pharyngitis
 Physician
 Pneumonia
 Prescription
 Randomized controlled trial
 Review
 Skin infection
 Soft tissue infection
 Surgical infection
 Thailand
 Treatment response
 Urinary tract infection
 Aged
 Communicable disease
 Health care facility
 Health care quality
 Hospital pharmacy
 Organization and management
 Pharmacist
 Procedures
 Standards
 Very elderly
 Adult
 Aged
 Aged, 80 and over
 Anti-Bacterial Agents
 Antimicrobial Stewardship
 Communicable Diseases
 Female
 Humans
 Male
 Middle Aged
 Patients' Rooms
 Pharmacists
 Pharmacy Service, Hospital
 Standard of Care
 Thailand

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URI

https://hdl.handle.net/20.500.14740/5835

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Scopus: Year 1983-2021

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