The impact of pharmacist-led education and prospective audit and feedback on antibiotic dose optimization within medical intensive care units in Thailand: a retrospective study
Background Critical illness can affect antimicrobial pharmacokinetics and pharmacodynamics. Antimicrobial stewardship programs promote appropriate antimicrobial usage. This study aimed to compare the appropriateness of antibiotic dosing, therapeutic drug monitoring, and ICU mortality before and afte...
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Taylor & Francis Group
2025-12-01
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| Series: | Journal of Pharmaceutical Policy and Practice |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/20523211.2025.2467456 |
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| author | Tipanong Gatechan Chotirat Nakaranurack Rongpong Plongla Thanawan Chuenjit Alan Edward Gross |
| author_facet | Tipanong Gatechan Chotirat Nakaranurack Rongpong Plongla Thanawan Chuenjit Alan Edward Gross |
| author_sort | Tipanong Gatechan |
| collection | DOAJ |
| description | Background Critical illness can affect antimicrobial pharmacokinetics and pharmacodynamics. Antimicrobial stewardship programs promote appropriate antimicrobial usage. This study aimed to compare the appropriateness of antibiotic dosing, therapeutic drug monitoring, and ICU mortality before and after antimicrobial stewardship program implementation in medical intensive care units.Methods This retrospective study was conducted at King Chulalongkorn Memorial Hospital, Thailand. Adults admitted to medical intensive care units from August 1, 2019, to July 31, 2021, who received selected antibiotics in the antimicrobial stewardship program were included. During the intervention period, general education as well as prospective audit with intervention and feedback were implemented by infectious disease pharmacist and clinical pharmacists. The appropriateness of dosing, therapeutic drug monitoring, and ICU mortality were compared before and after antimicrobial stewardship program implementation.Results There were 269 patients (455 prescriptions) and 376 patients (604 prescriptions) in the pre- and post-antimicrobial stewardship program implementation groups, respectively. Meropenem was the commonly prescribed antibiotic in both groups. Overall, the appropriateness of dosing and therapeutic drug monitoring improved after antimicrobial stewardship program implementation (36% to 63.58%, p < 0.001). Infectious disease and clinical pharmacists provided 40 interventions with an 87.5% acceptance rate. The most common recommendation was maintenance dose adjustment (79.17% acceptance rate). ICU mortality (29.37% to 18.62%, p = 0.001) and length of hospital stay in the ICU (7 days to 5 days, p = 0.005) were lower in the post-antimicrobial stewardship program implementation group.Conclusions Pharmacist-led education and prospective audit and feedback on antibiotic dose optimization can improve appropriate antibiotic dosing and therapeutic drug monitoring with a high acceptance rate. We suggest implementing this strategy in other intensive care units such as surgical intensive care units. We still found some nonadherence to our dosing guidelines; additional strategies to optimize dosing should be evaluated. |
| format | Article |
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| institution | OA Journals |
| issn | 2052-3211 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
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| series | Journal of Pharmaceutical Policy and Practice |
| spelling | doaj-art-dbe4ecf996214110be380a93d4c4d74d2025-08-20T02:30:08ZengTaylor & Francis GroupJournal of Pharmaceutical Policy and Practice2052-32112025-12-0118110.1080/20523211.2025.2467456The impact of pharmacist-led education and prospective audit and feedback on antibiotic dose optimization within medical intensive care units in Thailand: a retrospective studyTipanong Gatechan0Chotirat Nakaranurack1Rongpong Plongla2Thanawan Chuenjit3Alan Edward Gross4Clinical Pharmacy Unit, Department of Pharmacy, Sunprasitthiprasong Hospital, Ubon Ratchatani, ThailandDepartment of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, ThailandDivision of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, ThailandDepartment of Clinical Pharmacy Unit, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, ThailandDepartment of Pharmacy Practice, Retzky College of Pharmacy, University of Illinois Chicago, Chicago, IL, USABackground Critical illness can affect antimicrobial pharmacokinetics and pharmacodynamics. Antimicrobial stewardship programs promote appropriate antimicrobial usage. This study aimed to compare the appropriateness of antibiotic dosing, therapeutic drug monitoring, and ICU mortality before and after antimicrobial stewardship program implementation in medical intensive care units.Methods This retrospective study was conducted at King Chulalongkorn Memorial Hospital, Thailand. Adults admitted to medical intensive care units from August 1, 2019, to July 31, 2021, who received selected antibiotics in the antimicrobial stewardship program were included. During the intervention period, general education as well as prospective audit with intervention and feedback were implemented by infectious disease pharmacist and clinical pharmacists. The appropriateness of dosing, therapeutic drug monitoring, and ICU mortality were compared before and after antimicrobial stewardship program implementation.Results There were 269 patients (455 prescriptions) and 376 patients (604 prescriptions) in the pre- and post-antimicrobial stewardship program implementation groups, respectively. Meropenem was the commonly prescribed antibiotic in both groups. Overall, the appropriateness of dosing and therapeutic drug monitoring improved after antimicrobial stewardship program implementation (36% to 63.58%, p < 0.001). Infectious disease and clinical pharmacists provided 40 interventions with an 87.5% acceptance rate. The most common recommendation was maintenance dose adjustment (79.17% acceptance rate). ICU mortality (29.37% to 18.62%, p = 0.001) and length of hospital stay in the ICU (7 days to 5 days, p = 0.005) were lower in the post-antimicrobial stewardship program implementation group.Conclusions Pharmacist-led education and prospective audit and feedback on antibiotic dose optimization can improve appropriate antibiotic dosing and therapeutic drug monitoring with a high acceptance rate. We suggest implementing this strategy in other intensive care units such as surgical intensive care units. We still found some nonadherence to our dosing guidelines; additional strategies to optimize dosing should be evaluated.https://www.tandfonline.com/doi/10.1080/20523211.2025.2467456Pharmacist-lededucationprospective audit and feedbackantibioticdose optimizationmedical intensive care units |
| spellingShingle | Tipanong Gatechan Chotirat Nakaranurack Rongpong Plongla Thanawan Chuenjit Alan Edward Gross The impact of pharmacist-led education and prospective audit and feedback on antibiotic dose optimization within medical intensive care units in Thailand: a retrospective study Journal of Pharmaceutical Policy and Practice Pharmacist-led education prospective audit and feedback antibiotic dose optimization medical intensive care units |
| title | The impact of pharmacist-led education and prospective audit and feedback on antibiotic dose optimization within medical intensive care units in Thailand: a retrospective study |
| title_full | The impact of pharmacist-led education and prospective audit and feedback on antibiotic dose optimization within medical intensive care units in Thailand: a retrospective study |
| title_fullStr | The impact of pharmacist-led education and prospective audit and feedback on antibiotic dose optimization within medical intensive care units in Thailand: a retrospective study |
| title_full_unstemmed | The impact of pharmacist-led education and prospective audit and feedback on antibiotic dose optimization within medical intensive care units in Thailand: a retrospective study |
| title_short | The impact of pharmacist-led education and prospective audit and feedback on antibiotic dose optimization within medical intensive care units in Thailand: a retrospective study |
| title_sort | impact of pharmacist led education and prospective audit and feedback on antibiotic dose optimization within medical intensive care units in thailand a retrospective study |
| topic | Pharmacist-led education prospective audit and feedback antibiotic dose optimization medical intensive care units |
| url | https://www.tandfonline.com/doi/10.1080/20523211.2025.2467456 |
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