Mandatory Stop Dates, Indication Documentation Do Not Impact Length of Antibiotic Therapy

No difference was observed in any of the outcomes and there was no impact on the duration of therapy.

Shorter antibiotic therapy durations have been shown to be just as effective as longer therapy durations for many infections. Shorter durations of therapy have also resulted in fewer adverse events.

Recently, a community hospital added a computerized physician order entry (CPOE) system in the electronic health record, which requires indication, as well as the treatment duration to be documented on all antibiotic orders prior to order submission for pharmacist verification.

Investigators from the North Florida Regional Medical Center set out to determine if the implementation of this system would decrease the duration of therapy in hospitalized patients with bacterial pneumonia.

The data was presented at the 23rd Annual Making a Difference in Infectious Disease Meeting 2021 virtual sessions.

The retrospective, pretest-posttest, interrupted time series, quasi-experimental study included 138 patients, of which 56 were included in the pre-intervention group and 82 were included in the post-intervention group.

The patients were administered antibiotic therapy ≥ 48 hours for bacterial pneumonia between April 1, 2016, to May 1, 2016, and April 1, 2017, to May 1, 2017. The primary endpoint of the study was the length of therapy for antibiotics prescribed for bacterial pneumonia.

Findings from the study demonstrated that there was no difference found in the outcomes of length of hospital stay, 30-day readmission, in-hospital 30-day mortality, or incidence of in-hospital C. difficile infection.

Additionally, the median length of antibiotic therapy in the pre-intervention group was 4.4 days (IQR 2.9-5.9) and duration in the post-intervention group was 4.5 days (IQR: 3.5-5.2).

“Implementation of mandatory indication and default stop dates did not impact duration of inpatient antibiotic therapy for bacterial pneumonia patients. Requiring stop dates also did not result in harm,” the authors wrote. “Unmeasurable impacts of the required documentation includes enabling clinical evaluation of antibiotic orders, assessment for appropriateness of antibiotic selection by indication, and dose adjustments based on indication.”