Optimization
Î We recommend that hospitals implement pharmacokinetic
monitoring and adjustment programs for aminoglycosides (S-M) and
suggest the same for vancomycin (W-L).
• The conduct of both programs should be integrated into routine pharmacy
activities.
Î In hospitalized patients, we suggest ASPs advocate for the use of
alternative dosing strategies versus standard dosing for broad-
spectrum β-lactams to decrease costs (W-L).
• Although data for improved outcomes for broad-spectrum β-lactam dosing
with this approach are still limited, these interventions are associated with
antibiotic cost savings. ASPs should consider implementation but must take
into account logistical issues such as nursing and pharmacy education and need
for dedicated IV access.
Î We recommend ASPs implement programs to increase both
appropriate use of oral antibiotics for initial therapy and the timely
transition of patients from IV to oral antibiotics (S-M).
• IV-to-oral conversion of the same antibiotic is applicable to many healthcare
settings and should be integrated into routine pharmacy activities. ASPs
should implement strategies to assess patients who can safely complete therapy
with an oral regimen to reduce the need for intravenous catheters and to avoid
outpatient parenteral therapy.
Î In patients with a history of β-lactam allergy, we suggest that ASPs
promote allergy assessments and penicillin skin testing when
appropriate (W-L).
• Allerg y assessments and PCN skin testing can enhance use of first-line
agents. ASPs should promote such assessments with providers. In facilities
with appropriate resources for skin testing, the ASPs should actively work to
develop testing and treatment strategies with allergists.
Î We recommend that ASPs implement guidelines and strategies to
reduce antibiotic therapy to the shortest effective duration (S-M).
• Suitable approaches include developing written guidelines with specific
suggestions for duration, including duration of therapy recommendations as
part of the preauthorization or PAF process, or specifying duration at the time
of antibiotic ordering (e.g., through an electronic order entry system).
