ASP
Our ASP team consisted of an infectious diseases-trained clinical
pharmacist, infectious diseases physicians and hematologists. We
developed TUH’s recommended antibiotic and dosage regimen for empirical
therapy in febrile neutropenia, which adapted from the IDSA 2010 and
National Comprehensive Cancer Network (NCCN) 2020 guideline and
distributed to primary physician prior to the pharmacist-driven ASP was
implemented in two medical wards groups.5,15 In the
intervention group, clinical pharmacist performed daily prospective
audit and feedback to the primary physician. The pharmacist suggested a
suitable antibiotic for each patient, calculated an appropriate dose and
recommended the treatment duration for both empirical therapy and
documented infection. Antibiotic appropriateness and antibiotic
utilization in the intervention group was reported monthly by the
clinical pharmacist. Medical personnel practicing in the intervention
group were provided education via lectures and posters by the clinical
pharmacists during monthly ward conferences. No ASP interventions were
performed in the control group. The criteria to evaluate antibiotic
appropriateness was adapted from previous studies (supplementary data,
figure 1S).16-19 In empirical therapy evaluations, a
clinical pharmacist evaluated an appropriateness of indications,
antibiotic coverage, and dosage regimen of the antibiotics. Therapeutic
evaluations for documented infection were divided into 2 groups –
unknown source of infection, and known causative pathogens and source of
infection. Both groups were also evaluated for antibiotic indication,
dosage regimen, and duration of antibiotic therapy by pharmacist.
The primary outcome of this study was to compare antibiotic
appropriateness between pharmacist-ASP driven group and the control
group. Secondary outcomes were to compare antibiotic utilization,
patient length of stay, 30-day infectious diseases-related mortality
between the intervention and control groups. Target antibiotics in this
study were ceftazidime, cefepime, piperacillin/tazobactam, meropenem and
imipenem which are recommended as an empirical therapy for febrile
neutropenia in current guidelines.15, 20-21 All
intravenous antibiotics classes commonly used in these patients were
evaluated in this study.