Impact of antibiotic post-prescription authorization in resource-limited emergency rooms and acute care units during the COVID-19 pandemic.

Abstract

Background: Antimicrobial overuse is a major problem in various healthcare settings, including emergency rooms (ERs) and acute care units (ACUs). This study aimed to evaluate the impact of the post-prescription authorization (PPA) of antibiotics in these settings.

Methods: This retrospective observational study included ER and ACU patients at Siriraj Hospital. In August 2020, a PPA for piperacillin/tazobactam, meropenem, imipenem/cilastatin, and ertapenem was implemented. These antibiotics were unrestricted for the first 72 h; thereafter, infectious disease physician approval was required. Data from pre-implementation (July 2020) and post-implementation (September 2020) periods were compared.

Results: Two-hundred and six patients were included in the study (103 patients each from the pre- and post-implementation periods). There were no significant differences between the groups regarding male sex (49.5% vs. 47.6%;p = 0.78) and age (67.63 ± 22.9 vs. 66.94 ± 17.4 years;p = 0.27). The respiratory tract was the most common infection site, and piperacillin/tazobactam was the most frequently first-prescribed antibiotic. Using too narrow-spectrum antibiotics was the most common reason for inappropriate antibiotic use. The day of therapy/outpatient-day of the target antibiotics was significantly lower in the post-implementation group (0.85 ± 0.41 vs. 0.72 ± 0.39;p = 0.02). Favorable clinical outcomes were significantly higher in the post-implementation group (42.7% vs. 62.1%;p = 0.005).

Conclusions: This study demonstrates the positive impact of PPA in emergency settings, with a 15% reduction in antibiotic consumption and a 20% increase in favorable clinical outcomes. Future studies should evaluate PPA early in the course of treatment to identify the most effective interventions for improving the quality of care.