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Life sciences · Journal article
Antibiotics · September 7, 2026
Encouraging direction, but not yet definitive.
This pilot implementation study demonstrates feasibility of a carbapenem-sparing stewardship model using time-limited dispensing and mandatory reassessment in Internal Medicine wards. The intervention reduced antibiotic exposure by approximately 40% with no observed short-term signals of clinical worsening, but the study is underpowered to establish safety, non-inferiority, or equivalence, and a larger multicentre trial is required.
Prospective quasi-experimental before-and-after pilot implementation study. Consecutive adult inpatients receiving a carbapenem or fluoroquinolone in two Internal Medicine wards of a university hospital.. Intervention: Time-limited named-patient dispensing of targeted antibiotics for maximum initial duration of seven days, with pharmacist-supported reassessment on days 3 and 5 and mandatory infectious diseases reassessment for continuation beyond seven d…. Compared with: Standard care during 2-month control phase (initial prescription at discretion of treating physician without time limits or mandatory reassessment).. n = 78. Two Internal Medicine wards of a university hospital (location not specified)..
Antibiotic therapy duration was shorter in intervention group (median approximately 6 vs. 9 days, p = 0.0001) Antibiotic discontinuation by day 7 was more frequent in intervention group (81.6% vs. 45.0%, p = 0.001) Total targeted antibiotic exposure decreased by approximately 40% (mean 5.9 vs. 10.0 Defined Daily Doses per patient, p < 0.001)
Study explicitly not powered to establish safety, clinical non-inferiority, or equivalence; short-term safety signals only. Source does not report primary endpoint definition, adverse event rates, or microbial resistance outcomes.
Clinicians may consider this model as a feasible approach to reduce carbapenem overuse in complex inpatient settings, but should recognize that the pilot nature and small sample preclude definitive conclusions about safety or clinical efficacy. Larger randomized or multicentre studies are needed before widespread implementation.
Pilot quasi-experimental before-and-after study showing feasible reduction in carbapenem exposure with no observed short-term clinical harm, but underpowered for safety or efficacy and lacking a true control arm.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians may consider this model as a feasible approach to reduce carbapenem overuse in complex inpatient settings, but should recognize that the pilot nature and small sample preclude definitive conclusions about safety or clinical efficacy. Larger randomized or multicentre studies are needed before widespread implementation.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background/Objectives: Carbapenem overuse contributes to antimicrobial resistance, but pragmatic stewardship models for high-complexity Internal Medicine wards remain underreported. We evaluated the feasibility and stewardship impact of a carbapenem-sparing intervention based on time-limited named-patient dispensing, pharmacist-supported reassessment, and mandatory infectious diseases reassessment for continuation beyond seven days, while assessing short-term clinical outcomes as exploratory safety signals. Methods: We conducted a prospective quasi-experimental before-and-after pilot implementation study in two Internal Medicine wards of a university hospital. Consecutive adult inpatients receiving a carbapenem or fluoroquinolone were enrolled during a 2-month control phase (standard care, n = 40) and a subsequent 2-month intervention phase (n = 38). Initial prescription remained at the discretion of the treating physician; targeted antibiotics were dispensed on a named-patient basis for a maximum initial duration of seven days, with pharmacist-supported reassessment on days 3 and 5 and mandatory infectious diseases reassessment for continuation beyond seven days. Results: Antibiotic therapy duration was shorter in the intervention group (median approximately 6 vs. 9 days, p = 0.0001), and antibiotic discontinuation by day 7 was more frequent than in controls (81.6% vs. 45.0%, p = 0.001). Total targeted antibiotic exposure decreased by approximately 40% (mean 5.9 vs. 10.0 Defined Daily Doses (DDD) per patient, p < 0.001), mainly driven by reduced meropenem use. No significant differences were observed in biomarker trajectories, clinical status at day 7, 30-day readmission or relapse, or 90-day mortality. Conclusions: A time-limited dispensing and reassessment model was feasible in Internal Medicine and was associated with lower carbapenem and targeted restricted-antibiotic exposure. No apparent short-term signal of clinical worsening was identified, although the study was not powered to establish safety, clinical non-inferiority, or equivalence. Larger multicentre studies using standardized stewardship metrics are needed.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.