Category: Federal Forum Posters
Purpose: Cefdinir and cefuroxime are cephalosporins with similar antibacterial coverage. Both cefdinir and cefuroxime have similar indications with the exception of cefdinir being approved for community-acquired pneumonia and cefuroxime being approved for urinary tract infections. In November 2012, cefdinir was added to the VA Healthcare System’s national formulary. Subsequently, in January 2013, a cost-saving initiative identified cefdinir as first-line treatment in place of cefuroxime at VA Connecticut for community-acquired infections with the exception of urinary tract infections. However, the change was not clearly communicated at the VA Connecticut until May 2017 with an update to the restricted antibiotic list.
Methods: A retrospective, single center, chart review study was conducted at VA Connecticut. Patients were eligible for the study if there was a medication order for cefuroxime or cefdinir in the computerized patient record system (CPRS) from October 1, 2016 to November 30, 2017. A total of 200 patients were randomized for the study and separated into two groups to account for when the formulary change was communicated in May 2017. The first group included patients between October 1, 2016 to April 30, 2017, and the second group included patients between May 1, 2017 to November 30, 2017. All data was collected from CPRS and included patient age, gender, ethnicity, hospital location (inpatient or outpatient with clinic and provider), the antibiotic chosen, indication for use, dose, and duration of therapy. The primary outcome was a comparison of appropriateness of antibiotic selection for indication of use between the two study groups. The secondary outcomes were cost associated with inappropriate antibiotic selection, comparison of inpatient and outpatient antibiotic selection, and the percent of which inappropriate use of antibiotic was changed.
Joseph Walter– Student, University of Rhode Island, Bayonne, NJ