Pharmacist-driven antimicrobial optimization in the emergency department

This article reviewed the influence of a pharmacist-driven antimicrobial stewardship/ optimization service in a non-trauma emergency department of a hospital. The impact of a nurse-driven chart review was compared with a pharmacist-driven chart review. Impact was based on the number of clinical interventions made, along with resistance patterns identified from wound and urine cultures. The nurses assessed 499 patients with positive cultures, and intervened on 50% of the cultures which indicated the need for an intervention. The pharmacists assess 473 patients with positive cultures, and intervened on 80% of those that needed intervention. Interventions were based on inappropriate therapy. Also, E. coli, the most frequently isolated urinary organism, displayed a fluoroquinolone resistance rate of 38%.

This antimicrobial stewardship program showed 30% more pharmacist interventions compared to nurse interventions for “bug-drug” mismatches. Proper prescribing of antibiotics is an essential part of offsetting antibiotic resistance. This program shows that pharmacists are a key part of modifying antimicrobial therapies when needed. The high fluoroquinolone resistance rate suggests that alternative therapies may be better for some urinary tract infections, such as nitrofurantoin.

I thought this was an interesting article, because of the increase in antibiotic resistance and various efforts to offset this increase. It seems that the pharmacists are in a better position to assess and address proper prescribing of antibiotics than the nurses, because ultimately they are the medication experts. With this in mind, do you think it is beneficial for pharmacists to be able to prescribe antibiotics to patients?

Davis, L., Covey, R., Weston, J., et al. Pharmacist-driven antimicrobial optimization in the emergency department. Am J Health Pharm. 2016; 73:49-56. Doi: 10.2146/sp150036.


New Societal Approaches to Empowering Antibiotic Stewardship

All over the world, antibiotic resistance is a constant issue.  The CDC has issued statements about antibiotic stewardship, and now event the US Government wants to implement programs in hospitals to cut down on overuse of antibiotics.  Antibiotic “stewardship” is the description of these programs that will optimize the antibiotic selection process.

The first step is making sure hospitals are transparent and public about the frequency of health-care related infections along with making them commit to establishing these programs.  A lot of medical professionals need to be reminded that they are the only pharmacological entity that loses efficacy over extended use, so the the criteria for prescribing them should also be put under scrutiny.  If a well-defined system is put in place, with regulations on things like time frames of use or prior authorization for specific antibiotics before use, maybe they can crack down on the complication that is antibiotic resistance.

The article uses the example of fluroquinolones, the only antibiotic that is used to treat gram-negative bacilli.  Oftentimes, prescribers just resort to the antibiotic, where there are other treatment options readily available.  The more we prescribe antibiotics over other treatments, the more susceptible we make the patient and society in general to infections.  Here’s a situation where a guideline could be put in place.  Maybe if a diagnosis is reached, there could be a chart with potential action plans that prioritize antibiotics as a last option.


Spellberg B, Srinivasn A, Chambers H. New societal approaches to empowering antibiotic stewardship. JAMA. doi:10.1001/jama.2016.1346 (published 25 February 2016).