Effect of academic detailing on the utilization of intravenous antimicrobial therapy

Abstract

Antimicrobial agents constitute the largest proportion of a hospital's pharmaceutical budget. The present study was designed to determine the effect of pharmacy-based academic detailing on the use of imipenem-cilastatin, an antimicrobial agent of the carbapenem class of beta-lactams. Imipenem-cilastatin has a broad spectrum of activity that includes the majority of gram-negative and gram-positive pathogens, aerobes, and anaerobes, with marked activity against species producing beta-lactamases. The broad spectrum of activity of imipenem-cilastatin and its unit cost ($17.87 per dose) warranted close monitoring of physician's prescribing behavior in an effort to reduce antimicrobial resistance and expenditures. When diagnostic or laboratory data indicated the appropriateness of initiating an alternative therapeutic regimen (cefazolin or cefuroxime), a clinical pharmacist communicated these findings to the prescribing physician. The percentage of intravenous antimicrobial expenditures represented by imipenem-cilastatin in the 6 months before initiating the academic detailing program and the 18 months thereafter were 21.6% and 14.5%, respectively, for a 32.7% reduction in use. In the 23 cases during the experimental period in which academic detailing resulted in the use of an alternative intravenous antibiotic, cefuroxime was used in nine patients (39%) and cefazolin was used in 14 patients (61%), resulting in a cost savings of $2,992.19. Comparisons of patient outcomes between the pre- and post-periods revealed no significant difference in the average length of stay for patients with a primary diagnosis of infection, the average hospital charge for patients with a primary diagnosis of infection, or the average length of stay for all hospital admissions. The objective of academic detailing is to foster budgetary access to expensive therapeutic options by containing inappropriate use. Results indicate that academic detailing represents a flexible, peer-review process by which to optimize antimicrobial pharmacotherapy.