Briefly describe how you reassess antibiotic therapy in the ICU and why this is important for patient care.

My first step in reassessing antibiotic therapy is clarifying the indication with the primary team (if I don’t already know). This information is particularly important for me if it’s my first day on service. Based on the indication and the current regimen, I ask myself: 1) are we covering all of the likely pathogens; 2) are we missing any potential pathogens; and 3) do we still need the current coverage that we have? Then I look at all recent culture data and evaluate the appropriateness of current therapy. If, based on culture data, antibiotics should be narrowed or broadened, I will make this recommendation to the team. Based on the indication, I will recommend a duration of antibiotic therapy. If the team agrees, I will update the order with the correct end of treatment date. This daily assessment is incredibly important for patient care. In order to provide the best care for our patients, we must choose the most appropriate antibiotic for the shortest effective duration in order to reduce unnecessary exposure and prevent possible side effects. As pharmacists, we are the drug experts, so we must perform this reassessment every day for every patient on antibiotics to ensure we are advocating for the best possible care. I am not formally on our stewardship committee but collaborate with my ID colleagues daily—I think every pharmacist needs to be an antibiotic steward daily!

How do you educate all hospital pharmacists to reassess antibiotic therapy?

A great opportunity to educate all hospital pharmacists would be to hold a learning session over lunch. At UNMH, we have a built in “Lunch and Learn” session twice a week where pharmacists can volunteer to lead topic discussions, journal clubs, or provide resident education. If your pharmacy department does not already have something like this, you could initiate it! Holding an “antibiotic awareness” topic discussion would be a great way to teach every pharmacist how they can be antibiotic stewards by reassessing antibiotics every day.

What does "Being Antibiotics Aware" mean to you?

It means using the right drug for the right bug for the appropriate duration of treatment.

What is another way all pharmacists can Be Antibiotics Aware?

I have three important ways that all hospital pharmacists can be antibiotics aware. First, and specifically in the ICU, I am a big proponent of being aggressive with antibiotic dosing when appropriate, especially when patients are in septic shock. Underdosing antibiotics results in worse immediate clinical outcomes and is a risk factor for propagating antibiotic resistance. It is imperative to reassess renal function every day in order to optimize antimicrobial doses as kidney function changes. A second way that all hospital pharmacists can be antibiotics aware is to search the electronic medical record to see if any patient with a new infection has a history of a multidrug-resistant organism. Based on previous culture data, this may change your empiric antibiotic choices. And finally, pharmacists (or pharmacist extenders like students and interns) should investigate documented penicillin allergies to help the team make better antibiotic treatment decisions.

Eileen Shannon, PharmD, MS, BCCCP

Critical Care Pharmacist at University of New Mexico Hospital

PharmD, University of Wisconsin-Madison School of Pharmacy

PGY1 Residency, UW Health, Madison, WI

PGY2 Critical Care, UW Health, Madison, WI