Objective To evaluate the impact of pharmacist interventions on antibiotic use in inpatients with respiratory tract infections in a tertiary hospital in China. Method Two independent respiratory wards were randomized into control and intervention group. Between July 2009 and April 2010, all inpatients diagnosed with respiratory tract infections were enrolled. Pharmacist interventions were performed on the physicians in the intervention group. The total cost of hospitalization, cost of antibiotics, length of hospital stay and the scores of 6 items of inappropriate antibiotic use (including indication, choice, dosage, dosing schedule, duration and conversion) were analyzed. Results The total costs of hospitalization in the intervention group were significant lower compared to the control group ($1442.3 ± 684.9 vs. $1729.6 ± 773.7, P < 0.001), as well as the cost of antibiotics ($832.0 ± 373.0 vs. $943.9 ± 412.0, P = 0.01), and the patients required shorter length of hospital stay (14.2 ± 6.2 vs. 15.8 ± 6.0 days, P = 0.03). The scores with respect to the 6 items of inappropriate antibiotic use were all lower in the intervention group than in the control group. Conclusions Pharmacist interventions, interacted directly with the physicians at ward level, could play an important role in optimizing antibiotic use, thus lead to the reduction in patients’ length of hospital stay and health care cost.
Antibiotic use China Pharmacist interventions Respiratory tract infections
This is a preview of subscription content, log in to check access.
We thank all physicians and nurses who have participated in this study. We thank the pharmacy students for their assistance. Also we would like to thank Dr. Can Luo (Department of Pharmacy, Jiangsu Province Hospital, China) for helpful suggestions and critical reading of the manuscript.
John JF Jr, Fishman NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis. 1997;24(3):471–85.PubMedCrossRefGoogle Scholar
Heddini A, Cars O, Qiang S, Tomson G. Antibiotic resistance in China—a major future challenge. Lancet. 2009;373(9657):30.PubMedCrossRefGoogle Scholar
Reynolds L, McKee M. Factors influencing antibiotic prescribing in China: an exploratory analysis. Health Policy. 2009;90(1):32–6.PubMedCrossRefGoogle Scholar
von Gunten V, Reymond JP, Beney J. Clinical and economic outcomes of pharmaceutical services related to antibiotic use: a literature review. Pharm World Sci. 2007;29(3):146–63.CrossRefGoogle Scholar
Weller TMA, Jamieson CE. The expanding role of the antibiotic pharmacist. J Antimicrob Chemother. 2004;54(2):295–8.PubMedCrossRefGoogle Scholar
Zhu M, Guo DH, Liu GY, Pei F, Wang B, Wang DX, et al. Exploration of clinical pharmacist management system and working model in China. Pharm World Sci. 2010;32(4):411–5.PubMedCrossRefGoogle Scholar
Lodise TP, Lomaestro B, Drusano GL. Piperacillin-tazobactam for Pseudomonas aeruginosa infection: clinical implications of an extended-infusion dosing strategy. Clin Infect Dis. 2007;44(3):357–63.PubMedCrossRefGoogle Scholar
Hung MN, Hsueh PR, Chang HT, Lee WS, Chou MY, Chen IS, et al. In vitro activities of various piperacillin and sulbactam combinations against bacterial pathogens isolated from Intensive care units in Taiwan: SMART 2004 programme data. Int J Antimicrob Agents. 2007;29(2):145–52.PubMedCrossRefGoogle Scholar
Al-Momany NH, Al-Bakri AG, Makahleh ZM, Wazaify MM. Adherence to international antimicrobial prophylaxis guidelines in cardiac surgery: a Jordanian study demonstrates need for quality improvement. J Manag Care Pharm. 2009;15(3):262–71.PubMedGoogle Scholar
Vogel F. Intravenous/oral sequential therapy in patients hospitalised with community-acquired pneumonia: which patients, when and what agents? Drugs. 2002;62(2):309–17.PubMedCrossRefGoogle Scholar
Zhang R, Eggleston K, Rotimi V, Zeckhauser RJ. Antibiotic resistance as a global threat: evidence from China, Kuwait and the United States. Global Health. 2006;2:6.PubMedCrossRefGoogle Scholar
Deuster S, Roten I, Muehlebach S. Implementation of treatment guidelines to support judicious use of antibiotic therapy. J Clin Pharm Ther. 2010;35(1):71–8.PubMedCrossRefGoogle Scholar