2025 Southeastern Residency Conference

Title: Impact of Pharmacist Driven Ceftriaxone De-Escalation on Clinical Outcomes in Patients Hospitalized for Community-Acquired Pneumonia


Authors: Dana Olheiser, Avery Shawen, Ashley Byrd, Cameron Selent


Objective:


Self Assessment Question: Will implementation of pharmacist driven ceftriaxone de-escalation improve duration of treatment and hospital associated costs?


Background: The American Thoracic Society (ATS) / Infectious Diseases Society of America (IDSA) 2019 Community Acquired Pneumonia (CAP) Guidelines recommend a standard empiric intravenous (IV) regimen of a β-lactam plus a macrolide or an appropriate fluoroquinolone for the treatment of severe CAP. Specificities regarding the broadening or narrowing of antimicrobial therapies varies according to clinical severity, likelihood of pathogens and/or resistant organisms, and facility protocol. At Trident Medical Center, providers order empiric IV azithromycin and IV ceftriaxone for hospitalized CAP patients through predefined order sets. After 48-hours, if the patient is clinically stable and able to take oral therapy, IV azithromycin is de-escalated to oral therapy per pharmacist driven protocol. This study evaluates the impact of an adjunct pharmacist driven ceftriaxone de-escalation protocol.


Methods: 
This retrospective, single-center study evaluated the impact of the newly implemented pharmacist-driven  IV ceftriaxone de-escalation protocol in patients hospitalized for CAP. Patients were included if they were being treated for CAP with IV ceftriaxone and had already received 2 doses, were clinically improving, tolerating other oral medications, and had no other indications for treatment other than CAP. Patients will be de-escalated to amoxicillin/clavulanate if they have no known or reported history of penicillin allergy or to cefuroxime if they have a documented or reported mild to moderate allergic reaction to penicillin (excludes anaphylaxis and SJS/TENS).
This study analyzed primary endpoint of ceftriaxone de-escalation treatment success defined as improvement in white blood cell count (WBC), absence of fevers, and return to baseline oxygen requirements 24 hours after de-escalation. Additional secondary outcomes include time to de-escalation, duration of antimicrobial therapy and hospital length of stay. Safety outcomes include adverse drug reactions and 14-day readmission for CAP.  


Results: In progress


Conclusion: In progress