Antibiotics and Adverse Events

The Role of Antimicrobial Stewardship Programs in 'Doing No Harm'

Karri A. Bauer; Ravina Kullar; Mark Gilchrist; Thomas M. File Jr.

Disclosures

Curr Opin Infect Dis. 2019;32(6):553-558. 

In This Article

Significant Problem of Antibiotic-associated Adverse Events

The administration of antibiotics when they are not indicated is associated with unintended consequences, including antibiotic-specific ADEs, emergence of resistance, and selection of pathogenic bacteria, for example, Clostridium difficile. A recent study found that US adults aged at least 20 years had 145 490 emergency department (ED) visits attributed to antibiotic ADEs each year from 2011 to 2015.[7] Similarly, a Centers for Disease Control and Prevention (CDC)-authored study found that 70 000 ED visits were made annually for antibiotic ADEs among children aged of 19 years or less from 2011 to 2015, which accounts for 46.2% of ED visits for ADEs that results from systemic medication.[8] Both studies concluded that antibiotics are a common cause of ED visits for ADEs and represent an important opportunity for ASPs in optimizing patient safety. A single-center study quantified the incidence of ADEs associated with broad-spectrum antibiotics in a hospital setting.[9] The most frequently prescribed antibiotics were piperacillin/tazobactam, meropenem, and vancomycin. Of 689 patients, 118 (17.1%) experienced ADEs, including gastrointestinal (6.4%), hepatobiliary (4.2%), dermatologic (2.5%), and renal (2.3%) manifestations. Finally, a recent analysis evaluated the Food and Drug Administration (FDA) Adverse Event Report System to determine the association between C. difficile infection (CDI) and antibiotic classes.[10] A total of 5187 CDI reports were considered. Lincosamides (e.g., clindamycin) had the greatest proportion of CDI reports. CDI reporting odds ratios for the antibiotic classes were: lincosamides 46.95 (39.49–55.82), monobactam 29.97 (14.60–61.54), penicillin combinations 20.05 (17.39–23.12), carbapenems 19.16 (15.52–23.67), and cephalosporins 15.33 (12.60–18.65).

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