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EFFECTIVENESS OF ANTIBIOTIC STEWARDSHIP PROGRAM AND CLINICAL PHARMACY ACTIVITIES IN ANTIMICROBIAL THERAPY OF COPD EXACERBATION AT THONG NHAT HOSPITAL
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Abstract
Background: The rational use of antibiotics in the treatment of chronic obstructive pulmonary disease (COPD) exacerbation has been shown in several studies to reduce treatment failure, length of hospital stays, and mortality rate. At Thong Nhat hospital, the antimicrobial stewardship program (ASP) and clinical pharmacy activities are regularly implemented with the goal of increasing the rational antibiotic use. Objective: To evaluate the effectiveness of ASP and clinical pharmacy activities in appropriate antimicrobial therapy in patients with COPD exacerbation. Methods: A before and after, cross – sectional study was conducted on medical records of patients diagnosed with COPD exacerbation at Department of Respiratory, Thong Nhat hospital. The study consisted of two phases before and after the implementation of ASP and clinical pharmacy activities: phase 1 from June 2018 to May 2019 (n = 110), and phase 2 from June 2019 to May 2020 (n=107). The appropriateness of antibiotic use was assessed based on 2019 GOLD guideline and the 2018 National COPD guideline. The primary endpoint to evaluate the effectiveness of the ASP and clinical pharmacy activities was the appropriate rate of antibiotic use. Results: The mean age of patients was 73.7 ± 11.3 y.o. and 88.9% were male. Most of patients were diagnosed with a moderate COPD exacerbation. Third-generation cephalosporins and fluoroquinolone were the most common antibiotic groups used in patients. The overall appropriate rate of empiric antibiotic use in all stages was 84.8%. The ASP and clinical pharmacy activities significantly increased the overall appropriate rate of empiric antibiotic (90.8% vs 78.8%, respectively). Conclusion: ASP and clinical pharmacy activities improve guideline-concordant empiric antimicrobial therapy. Adherence to COPD exacerbation treatment guideline is necessary to increase the drug safety and rationality.
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Keywords
antibiotics, COPD exacerbation, ASP, clinical pharmacy
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