Title: Pharmacy-directed optimization of appropriate anaerobic antibiotic coverage Authors: Amita Singh, PharmD; Brenden Van Slyke, PharmD; JoMarie Yazak BS Learning Objective: Analyze the impact of pharmacist intervention and EMR-based decision support on antimicrobial stewardship outcomes, including inappropriate double anaerobic coverage use Background/Objective: This study aims to reduce unnecessary double anaerobic coverage by promoting de-escalation per institutional policy, thereby minimizing antibiotic overuse. Methods: This two-phase study will compare double anaerobic antibiotic coverage practices before and after pharmacist-led intervention. Phase one involves a retrospective chart review in the legacy system (May-September 2025) as the control, identifying all patients receiving double anaerobic coverage. Phase two is a prospective intervention period in Epic (November 2025-March 2026), where pharmacists will evaluate and de-escalate inappropriate double anaerobic coverage when clinically appropriate. Eligible patients are at least 18 years old, on double anaerobic coverage for at least 24 hours. The primary outcome is the percentage of antibiotic therapy days with guideline-inappropriate double anaerobic coverage, measured before and after intervention. Secondary outcomes include the proportion of patients on appropriate double anaerobic coverage per system guidelines and incidence of Clostridioides difficile infection. Descriptive statistics were used to summarize outcomes, and Fisher’s Exact Test was used to compare groups, with p<0.05 considered statistically significant.
Results: In a single-center study, inappropriate double anaerobic coverage (DAC) decreased significantly following EPIC implementation (42.6% vs 16.1%, p=0.0119), while pharmacist interventions occurred in only two cases. Appropriate DAC use increased (40% to 81.8%) but was not statistically significant. No C. difficile infections were observed. Results suggest EMR-based decision support played a key role in improving prescribing practices.
Conclusion: EPIC implementation was associated with a significant reduction in inappropriate double anaerobic coverage, while pharmacist interventions were limited. Although appropriate DAC use increased, this was not statistically significant. These findings suggest that EMR-based decision support may play a key role in improving antibiotic prescribing practices, with pharmacists remaining an important component of antimicrobial stewardship efforts.
Self-Assessment Question: Which of the following scenarios is most likely to represent inappropriate double anaerobic antibiotic coverage (DAC)? A. Necrotizing soft tissue infection with concern for toxin production requiring clindamycin B. Intra-abdominal infection treated with piperacillin-tazobactam and metronidazole without additional indication C. Severe polymicrobial infection with delayed source control and hemodynamic instability D. Empiric therapy in a patient with suspected mixed aerobic-anaerobic bacteremia pending cultures
