#58: Identification of the most frequent mistakes in the prescription of antibiotics using the “Time-out” strategy, in a pediatric hospital in Mexico City.
Authors: Mondragón Izveidy , Arias Eduardo , Huante Alfonso , Díaz Luisa 
Published: June 2021

Abstract

Background
In 2019, the CDC estimated that each year more 2.8 million antibiotic resistant infections ocurr in the United States and more than 35,000 pepole die a a result.Usually in pediatrics, antibiotics are the most prescribed, reviews have demonstrated that 37 to 61% of hospitalized infants and children receive antibiotics and 20 to 50% of these prescriptions are unnecessary either the dosage or duration are incorrect. Antibiotic resistance is an increasing worldwide problem. Effective antimicrobial stewardship programs has been demostrated reduce the inappropriate use and optimizing antimicrobial selection, dosing, route, and duration of terapy, limiting the consequences such adverse drug, resistance and cost.4 The antibiotic time-out consists in reassessment of the continuing need and choise of aantibiotics when the clinical picture is clearer and we have more diagnostic information. Currently, in our institution there is no established stewardship program and the costs attributable to antimicrobial use have been estimated at 1.6 million dollars. The goal of this project was to identify the most common prescription mistakes using the “Time-out” strategy because of its structured applicability and simplified revision that guides antimicrobial use.

Methods
From May to October 2020, we carried out a time out evaluation for different antimicrobial prescriptions in the five main wards of the INP; it consisted of data collection through a mobile application where the prescriptions were documented and evaluated. We answered three questions: 1) Based on the patient′s clinical course and diagnostic test, is the use of these antibiotics justified? 2)Is the dose, interval and route of administration correct? 3) What is the estimated duration of treatment? An infectious disease specialist evaluated the antimicrobial prescriptions daily and, if necessary, modified or adjusted it during rounds. Our evaluation was carried out between 24 and 72 hours of treatment initiation.

Results
For a 6 month period, 196 antimicrobial prescriptions were evaluated through the time-out strategy. Of them, 48% were from de group of cephalosporins followed by the glycopeptides (16%) and carbapenems (14.3%). In 23% of cases they were not medically justified and 53% of them required either discontinuation, narrowing of broadening of spectrum. The prevalence of antibiotic prescription errors was 23%. In 30% of cases it was a dose per kg of body weight error, 61% total dose per day and 9% in duration of treatment. Of note, there were 26% of these prescriptions were instances where the antimicrobials were not prescribed by a pediatric infectious disease specialist where 67% was not found to be justified upon evaluation and 72% required discontinuation.

Conclusions
The implementation of an antimicrobial control program made it possible to identify the most common mistakes in antibiotic prescription in our hospital, confirming the relevance of these programs to reduce the inappropriate use of antimicrobial prescriptions, limiting the consequences such adverse effects drug, antimicrobial resistance and healthcare cost.