Impacts of Pharmacy Intervention on Appropriateness of Antibiotics Use in Pneumonia Patients

Authors

  • Azizah Nasution Department of Pharmacology https://orcid.org/0000-0002-1870-3930
  • Khairunnisa Khairunnisa Department of Pharmacology, Faculty of Pharmacy, Universitas Sumatera Utara, Medan, Indonesia
  • Syed Azhar Syed Sulaiman Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia

DOI:

https://doi.org/10.3889/oamjms.2021.6575

Keywords:

Pneumonia, Antibiotics rationality, Gyssens

Abstract

AIM: This study analyzed the impact of pharmacy intervention on appropriateness of antibiotics use in the treatment of inpatients with pneumonia admitted to Universitas Sumatera Utara (USU) Hospital, Medan, Indonesia.

METHODS: This cohort study analyzed appropriateness of antibiotic use in the treatment of in-patients with pneumonia without interventions or baseline group (n = 33) admitted to USU Hospital year 2018 and 3-month period admission with pharmacy intervention (n = 42) year 2019. Characteristics of the patients and antibiotics provided to both groups were descriptively analyzed. The appropriateness of antibiotics use in both groups was analyzed based on their medical conditions, culture and sensitivity tests, and trustable literatures, and then categorized applying Gyssens method regarding dose, intervals, routes, length of provision, effectivity, and costs. The significant difference in inappropriate use of antibiotics between groups with and without interventions was analyzed applying unpaired t-test (p < 0.05 was considered statistically significant).

RESULTS: Most of the pneumonia patients in both groups were male. Mean age of the patients (years) in group: without intervention, 60.20 ± 15.48; with intervention, 60.48 ± 14.76. The three most widely provided antibiotics were ceftriaxone, meropenem, and ciprofloxacin. Incidence of inappropriate use of antibiotics per patient in group: without intervention, 0.66; with intervention, 0.33. The inappropriate use of antibiotics reduced significantly in group with intervention, p = 0.049.

CONCLUSIONS: Pharmacy intervention is crucial to reduce the inappropriate use of antibiotics in the treatment of pneumonia.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet. 2011;377(9773):1264-75. https://doi.org/10.1016/s0140-6736(10)61459-6 PMid:21435708 DOI: https://doi.org/10.1016/S0140-6736(10)61459-6

World Health Organization. The Top Ten Causes of Death. Geneva: World Health Organization; 2019. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. [Last accessed on 2019 Nov 30].

Ministry of Health, Agency of Health Research and Development. Main Results of RISKESDAS 2018. Jakarta: Balitbangkes Ministry of Health; 2018.

Prasso JE, Deng JC. Postviral complications: Bacterial pneumonia. Clin Chest Med. 2017;38(1):127-38. https://doi.org/10.1016/j.ccm.2016.11.006 PMid:28159155 DOI: https://doi.org/10.1016/j.ccm.2016.11.006

Radovanovic D, Sotgiu G, Jankovic M, Mahesh PA, Marcos PJ, Abdalla MI, et al. An international perspective on hospitalized patients with viral community-acquired pneumonia. Eur J Intern Med. 2019;60:54-70. PMid:30401576

Korsun N, Angelova S, Trifonova I, Georgieva I, Voleva S, Tzotcheva I, et al. Viral pathogens associated with acute lower respiratory tract infections in children younger than 5 years of age in Bulgaria. Braz J Microbiol. 2019;50(1):117-25. https://doi.org/10.1007/s42770-018-0033-2 PMid:30637646 DOI: https://doi.org/10.1007/s42770-018-0033-2

Dimov GS, Karakolev ZT, Kalchev IY, Dobrev KD. Ventilatorassociated pneumonia in patients with cerebral depression. Folia Med (Plovdiv). 2009;51(1):56-60. PMid:19437899

Medscape References. Community-Acquired Pneumonia (CAP) Clinical Practice Guidelines; 2019. Available from: https://www.reference.medscape.com/viewarticle/920604. [Last accessed on 2021 May 12].

Moreira MR, Guimarães MP, Rodrigues AA, Gontijo Filho PP. Antimicrobial use, incidence, etiology and resistance patterns in bacteria causing ventilator-associated pneumonia in a clinical-surgical intensive care unit. Rev Soc Bras Med Trop. 2013;46(1):39-44. https://doi.org/10.1590/0037-868216722013 PMid:23563823 DOI: https://doi.org/10.1590/0037-868216722013

Okada N, Fushitani S, Azuma M, Nakamura S, Nakamura T, Teraoka K, et al. Clinical evaluation of pharmacist interventions in patients treated with anti-methicillin-resistant Staphylococcus aureus agents in a hematological ward. Biol Pharm Bull. 2016;39(2):295-300. https://doi.org/10.1248/bpb.b15-00774 PMid:26830489 DOI: https://doi.org/10.1248/bpb.b15-00774

Restrepo MI, Reyes LF, Anzueto A. Complication of communityacquired pneumonia (including cardiac complications). In: Seminars in Respiratory and Critical Care Medicine. Vol. 37. New York, United States: Thieme Medical Publishers; 2016. p. 897-904. https://doi.org/10.1055/s-0036-1593754 DOI: https://doi.org/10.1055/s-0036-1593754

Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: Updating the cost-of-illness model. J Am Pharm Assoc (Wash). 2001;41(2):192-9. https://doi.org/10.1016/s1086-5802(16)31229-3 PMid:11297331 DOI: https://doi.org/10.1016/S1086-5802(16)31229-3

Cole J, Stark JE, Hodge B. A primary hospital antimicrobial stewardship intervention on pneumonia treatment duration. Fed Pract. 2017;34(2):14-8. PMid:30766252

Dunaway S, Orwig KW, Arbogast ZQ, Myers ZL, Sizemore JA, Giancola SE. Evaluation of a pharmacy-driven methicillinresistant Staphylococcus aureus surveillance protocol in pneumonia. Int J Clin Pharm. 2018;40(3):526-32. https://doi.org/10.1007/s11096-018-0647-3 PMid:29721739 DOI: https://doi.org/10.1007/s11096-018-0647-3

Subedi B, Louzon P, Zappas K, Onyia W, DeBoer K. Impact of pharmacist-led procalcitonin-guided antibiotic therapy in critically ill patients with pneumonia. Hosp Pharm. 2020;55(3):204-10. https://doi.org/10.1177/0018578719836643 PMid:32508359 DOI: https://doi.org/10.1177/0018578719836643

Allerberger F, Amann S, Apfalter P, Brodt HR, Eckmanns T, Fellhauer M, et al. Strategies to enhance rational use of antibiotics in hospital: A guideline by the German society for infectious diseases. Infection. 2016;44(3):395-439. https://doi.org/10.1007/s15010-016-0885-z PMid:27066980 DOI: https://doi.org/10.1007/s15010-016-0885-z

World Health Organization. Regional Office for the Western Pacific. Health Research Methodology: A Guide for Training in Research Methods. Geneva: World Health Organization; 2001.

Medscape. Bacteria Pneumonia Treatment and Management. Available from: https://www.emedicine.medscape.com/article/300157-treatment#d8. [Last accessed on 2021 May 12].

Gyssens IC. Audit for monitoring the quality of antimicrobial prescription. In: Gould IM, van der Meer WM, editors. Antibiotikas Policies: Theory and Practice. New York: Spinger; 2005. p. 197-226. DOI: https://doi.org/10.1007/0-387-22852-7_12

Kalil AC, Metersky ML, Klompas M, Muscedere, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the infectious diseases society of America and the American thoracic society. Clin Infect Dis. 2016;63(5):e61-111. https://doi.org/10.1093/cid/ciw353 PMid:27418577 DOI: https://doi.org/10.1093/cid/ciw353

Lim WS, Smith DL, Wise MP, Welham SA. British thoracic society community acquired pneumonia guideline and the NICE pneumonia guideline: How they fit together. BMJ Open Respir Res. 2015;2(1):e000091. https://doi.org/10.1136/bmjresp-2015-000091 PMid:26019876 DOI: https://doi.org/10.1136/bmjresp-2015-000091

Henig O, Kaye KS. Bacterial pneumonia in older adults. Infect Dis Clin. 2017;31(4):689-713. PMid:28916385 DOI: https://doi.org/10.1016/j.idc.2017.07.015

Kothe H, Bauer T, Marre R, Suttorp N, Welte T, Dalhoff K, et al. Outcome of community-acquired pneumonia: Influence of age, residence status and antimicrobial treatment. Eur Resp J. 2008;32(1):139-46. https://doi.org/10.1183/09031936.00092507 PMid:18287129 DOI: https://doi.org/10.1183/09031936.00092507

Menéndez R, Torres A, de Castro FR, Zalacaín R, Aspa J, Villasclaras JJ, et al. Reaching stability in community-acquired pneumonia: The effects of the severity of disease, treatment, and the characteristics of patients. Clin Infect Dis. 2004;39(12):1783-90. https://doi.org/10.1086/426028 PMid:15578400 DOI: https://doi.org/10.1086/426028

What Antibiotics are Used to Treat Pneumonia? 2019. Available from: https://www.drugs.com/medical-answers/antibiotics-treatpneumonia-3121707. [Last accessed on 2019 Dec 02].

Leekha S, Terrell CL, Edson RS. General principles of antimicrobial therapy. In: Mayo Clinic Proceedings 2011. Vol. 86. Amsterdam, Netherlands: Elsevier; 2011. p. 156-67. https://doi.org/10.4065/mcp.2010.0639 DOI: https://doi.org/10.4065/mcp.2010.0639

DailyMed. Ceftriaxone: Dosage and Administration. Available from: https://www.dailymed.nlm.nih.gov/dailymed/drugInfo. cfm?setid=9bcf7973-54fa-487c-99da-db8a92b5e074. [Last accessed on 2021 May 12].

Leung E, Weil DE, Raviglione M, Nakatani H. The WHO policy package to combat antimicrobial resistance. Bull World Health Organ. 2011;89(5):390-2. https://doi.org/10.2471/blt.11.088435 PMid:21556308 DOI: https://doi.org/10.2471/BLT.11.088435

Centers for Disease Control and Prevention. Antibiotic Prescribing and Use in Doctor’s Offices. Continuing Education and Informal Resources; 2020. Available from: https://www.cdc.gov/antibiotic-use/community/index.html. [Last accessed on 2020 Sep 19].

Azizah N, Azhar SS, Ainnal SA. Evaluation of antibiotics utilization and dosing for management of patients with chronic kidney disease in an Indonesian hospital. Asian J Pharm Clin Res. 2015;8(1):29-302.

Pogue JM, Kaye KS, Cohen DA, Marchaim D. Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens. Clin Microbiol Infect. 2015;21(4):302-12. https://doi.org/10.1016/j.cmi.2014.12.025 PMid:25743999 DOI: https://doi.org/10.1016/j.cmi.2014.12.025

Herawati R. Review of Antibiotic Utilization in St. Vincentius A Paulo Hospital, Surabaya. Indonesia: Universitas Surabaya; 2006.

Faizah AK, Putra ON. Qualitative evaluation of antibiotic therapy in patients with pneumonia at Surabaya Indonesia teaching hospital. JSFK J Pharm Sci Clin. 2019;6(2):129-33. DOI: https://doi.org/10.25077/jsfk.6.2.129-133.2019

World Health Organization. Rational Use of Medicines, Fact Sheet No. 338. Geneva: World Health Organization; 2010. Available from: http://www.who.int/mediacentre/factsheets/fs338/en. [Last accessed on 2017 Oct 22].

Kuzman I, Bezlepko A, Topuzovska IK, Rokusz L, Iudina L, Marschall HP, et al. Efficacy and safety of moxifloxacin in community acquired pneumonia: A prospective, multicenter, observational study (CAPRIVI). BMC Pulm Med. 2014;14:105. https://doi.org/10.1186/1471-2466-14-105 PMid:24975809. DOI: https://doi.org/10.1186/1471-2466-14-105

Zilberberg MD, Nathanson BH, Sulham K, Fan W, Shorr AF. Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with enterobacteriaceae urinary tract infection, pneumonia and sepsis. BMC Infect Dis. 2017;17(1):279. https://doi.org/10.1186/s12879-017-2383-z PMid:28415969 DOI: https://doi.org/10.1186/s12879-017-2383-z

Downloads

Published

2021-07-28

How to Cite

1.
Nasution A, Khairunnisa K, Sulaiman SAS. Impacts of Pharmacy Intervention on Appropriateness of Antibiotics Use in Pneumonia Patients. Open Access Maced J Med Sci [Internet]. 2021 Jul. 28 [cited 2024 Mar. 29];9(B):786-92. Available from: https://oamjms.eu/index.php/mjms/article/view/6575

Issue

Section

Infective Diseases

Categories

Most read articles by the same author(s)