Comprehensive Summary
This retrospective observational study examined the impact of antibiotic post-prescription authorization (PPA) in the emergency department (ED) and acute care unit (ACU) of a single hospital in Thailand during the COVID-19 pandemic. In August 2020, the hospital’s introduced a PPA protocol for antibiotics such as carbapenems and piperacillin/tazobactam. These agents could be prescribed freely in the first 72 hours, but required approval from an infectious disease physician for continued use thereafter. The study compared103 patients treated before PPA implementation (July 2020) with 103 patients treated after PPA implementation (September 2020). Days of therapy (DOT) with target antibiotics per outpatient-day (OPD-day) were significantly lower after implementation compared with before (0.72 ± 0.39 vs 0.85 ± 0.41; p=0.02). Favorable clinical outcomes were also significantly more frequent after implementation (62.1% vs. 42.7%; p = 0.005). There was no significant difference in cost of target antibiotics per OPD-day between groups (US$ 12.39 ± 8.23 vs. US$ 12.02 ± 7.84; p = 0.74).
Outcomes and Implications
Antibiotic overuse in emergency and acute care settings remains a major challenge contributing to resistance and poor outcomes. This study demonstrated that implementing an antibiotic PPA protocol reduced target antibiotic duration and improved clinical outcomes, but there was no effect on cost. Despite limitations including its retrospective, single-center design, short duration, and missing data, the findings suggest that antibiotic PPA implementation is feasible in emergency and acute care units. Large multicenter prospective studies are warranted to confirm these results and refine strategies for implementing antibiotic PPA.