Shorter Prescription Stop Dates Do Not Influence Antibiotic Treatment Duration

Antibiotic prescription stop dates may not influence the duration of actual treatment in patients with common infectious diseases, according to a new study.

In new research data presented at the Making A Difference in Infectious Disease (MAD-ID) 2021 Annual Meeting this week, investigators from the University of North Carolina reported no significant difference of total antibiotic therapy length for prescribed patients being discharged from the hospital.

The new retrospective cohort study indicates the need for bolstered education on antibiotic prescribing effect, and an emphasis on shorter therapy durations for such patients.

Led by Maggie Hitchins, PharmD, of WakeMed Health & Hospitals in Raleigh, investigators sought to evaluate the impact of 5-day versus 10-day discharge antibiotic prescription default stop dates on the total length of therapy for such patients. Their observation took place in a community health system which had reduced its default prescription stop date from 10 days to 5 days in February 2020, in an effort to increase stewardship.

“Prolonged durations of antibiotic therapy increase the risk of resistance, Clostridioides difficile infection (CDI), and adverse events,” Hitchins and colleagues wrote. “Given the growing body of evidence supporting shorter antibiotic durations for common infectious diseases, antibiotic prescribing at discharge has become a target for many antimicrobial stewardship programs.”

The team assessed hospitalized adult patients who had been discharged with an oral antibiotic prescription either between December 2019 – January 2020 (pre-implementation), or between March 2020 – April 2020 (post-implementation. Patients had been discharged with a diagnosis of pneumonia, urinary tract infection (UTI), pyelonephritis, or skin and soft tissue infections.

Investigators excluded pediatric patients, pregnant patients, and those with treatment for opportunistic infection or COVID-19 pneumonia. Eligible patients were stratified by 3 care sites, and randomly selected until 300 were included at a 6:3:1 by site in each group to control for discharge prescription trends across the health system.

Patients were 53% female, with a median age of 66 years old. Just more than half (51%) had a pneumonia diagnosis at discharge.

Median total duration of antibiotic therapy was 9 days (IQR, 8-12) in the pre-implementation group, and 9 days (IQR, 7-12) in the post-implementation group (P = .051).

However, duration of 7 days or less was more frequently reported among the post-implementation group (32% vs 25%; P = .070).

Investigators did not observe a difference in incidence of 5-day discharge antibiotic prescriptions (23% vs 28%; P = .190), 30-day ED visits (19% vs 14%; P = .124), 30-day readmissions (14% vs 9%; P = .073), or CDI incidence within 30 days of discharge (0.3% vs 0.0%; P = .916) among patients in the pre-implementation or post-implementation group, respectively.

Hitchins and colleagues concluded the findings indicate a need for stewardship strategies beyond shortened antibiotic prescription stop dates.

“Reducing the discharge antibiotic prescription default stop date did not impact the total length of antibiotic therapy for common infectious diseases,” they wrote. “These results demonstrate a need for provider education on shorter duration of therapy for common infectious diseases and to consider total duration of treatment when writing an antibiotic prescription at discharge.”