Antimicrobial stewardship programs (ASP) oversee administration of medications for the prevention and treatment of infectious diseases to ensure appropriate, cost effective use of these medications. Acyclovir is an antiviral agent most often used to treat herpes virus infections in pediatric patients, including neonatal herpes simplex virus (HSV) infections, encephalitis, and mucocutaneous infections. In 2013 there was a national shortage of intravenous (IV) acyclovir and hospital supply was limited. The ASP implemented an acyclovir restriction policy and modification of the electronic health record beginning January 10 2013 that required approval from an infectious diseases physician for usage. We aimed to evaluate the impact of an ASP restriction policy on the utilization of IV acyclovir in a children’s hospital.
We undertook a retrospective cohort study comparing utilization of IV acyclovir pre- and post-implementation of a restriction policy with prospective monitoring at a tertiary care children’s hospital. All patients receiving IV acyclovir were eligible for inclusion from Jan 2011 to Dec 2015. Medication administration records were analyzed for the entire study period. The total number of doses per year and days of therapy (DOT) per 1000 patient-days were calculated. Indications for use were described.
In the pre-implementation period (2011-2012), 1192 and 1380 doses were given per year, with DOT/1000 patient-days of 11 and 12 respectively. Post-implementation (2013, 2014 and 2015), 778, 625 and 898 total doses of acyclovir were administered per year, with DOT/1000 patient-days of 8, 6, and 9 respectively. Neonatal HSV infection was the most common indication for use throughout the study period.
Implementation of a restriction policy for IV acyclovir resulted in a decrease in days of therapy administered to pediatric patients when standardized by 1000 patient-days. While this policy was created at the time of a drug shortage, it effectively reduced use of IV acyclovir and will remain a part of our ASP. Incorporation of similar restriction policies for other medications can reduce unnecessary use of antimicrobials in pediatric patients.
S. Chan, None
S. Kapfer, None