Original Research
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction: Aminoglycoside antibiotics have a narrow therapeutic index, and medication-use evaluation at our institution revealed errors in their use. Therefore, a pharmacist-managed protocol was established for dosing and monitoring.
Research Question or Hypothesis: Will a pharmacist-managed aminoglycoside protocol improve bacteriologic cure, maintain levels within range, and reduce acute kidney injury (AKI)?
Study Design: A single-center pre- and post-intervention study
Methods: The study included all patients who received intravenous amikacin or gentamicin for >24 hours in the year before protocol implementation and ended when the same number of eligible patients was reached after protocol. The pre-intervention period was April 1, 2016, to April 2, 2017, and the post-intervention period was April 3, 2017, to January 13, 2018. Pregnant and under-14 patients were excluded because medical staff managed them. The primary endpoint was bacteriologic cure, measured by negative cultures after aminoglycosides. The rate of AKI according to the Acute Kidney Injury Network criteria, the number of patients achieving therapeutic levels, and the appropriateness of monitoring, defined by serum aminoglycoside levels after initiation and SrCr within a week before and 48 hours after initiation, were secondary endpoints. The Chi-square test compared nominal frequencies (percentages). The t-test compared SD-presented continuous, normally distributed means. For nonparametric frequencies, Mann-Whitney U test was used. A two-sided p value of 0.05 was used to define statistical significance, and for statistical test comparisons, IBM SPSS Statistics software version 26 was used.
Results: The study included 102 patients (51 per phase). Bacteriologic cure occurred in 25 patients (49%) before intervention and 37 (73%) after [p=0.015]. Five patients (9.8%) had AKI before and four (7.8%) after [p=0.727]. Twelve patients (23%) achieved therapeutic aminoglycoside serum levels before and 30 (58%) after [p<0.001]. Thirty-three patients (64%) were not appropriately monitored before and 7 (13%) after [p<0.001].
Conclusion: In this study, a pharmacist-managed aminoglycoside protocol improved bacteriologic cure and maintained aminoglycoside levels within range.
Presenting Author
Sulaiman A Al-Zubairy PharmD, MBA, BCPS, BCOP, SIDP, LSSGBJohns Hopkins Aramco Healthcare
Authors
Fatimah Al Johani PharmD, BCACP
Prince Sultan Armed Force Hospital