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.