Medical Staff Pulse Newsletter

Antimicrobial stewardship progress report

Pharmacy focus

Promoting appropriate antimicrobial selection, dose, route of administration, and duration are integral components of a continuing initiative to promote antimicrobial stewardship and reduce resistance to drugs. Duration of therapy has been a recent area of focus.

Since December 2009, specificbroad spectrum gram-negative active antibiotics (piperacillin/tazobactam, cefepime, imipenem, meropenem, levofloxacin and ciprofloxacin) have been assessed a five-day automatic stop date, with alerts provided to notify physicians that the antibiotic will expire.

Last year, the Antimicrobial Utilization Review Committee and the Pharmacy and Therapeutics Committee approved expanding the number of antibiotics with a five-day stop date to all antimicrobials (with exceptions, including a number of agents utilized in prophylactic regimens and non-ID related uses). This change will go into effect within the next several weeks. As is the current practice, physicians will be notified via alerts that an antimicrobial will expire.

Ongoing promotion of antimicrobial stewardship is embedded in Cedars-Sinai's Patient Safety Goal of reducing antimicrobial resistance. These efforts also are in compliance with the California Department of Public Health's Antimicrobial Stewardship Program Initiative as well as the mandates of state Senate Bill 739, stating "general acute care hospitals monitor and evaluate the utilization of antibiotics and charge a quality improvement committee with the responsibility for oversight of the judicious use of these medications."