Use of Double Anaerobic Coverage and its Implications

Abstract

Specific Aims: Metronidazole and clindamycin can be prescribed for anaerobic infections; however, patients are periodically prescribed a second agent with duplicate anaerobic coverage. The purpose of this project was to evaluate the frequency, appropriateness, and potential consequences of combination therapy against anaerobic organisms in patients prescribed metronidazole or clindamycin. Methods: In this IRB approved project, adult patients who were prescribed either intravenous metronidazole or intravenous clindamycin with or without another agent with anaerobic coverage for at least 48 hours at an academic medical center between May 2010 and April 2012 were evaluated. Subjects were excluded if documented Clostridium difficile associated diarrhea within 14 days prior to intravenous metronidazole, if use of oral vancomycin within 14 days prior to intravenous metronidazole, or if presence of diarrhea with more than six unformed stools 48 hours prior to intravenous metronidazole. Data collected includes demographic information, site of infection, surgical interventions, antibiotic therapy prescribed, therapy outcomes, and reported adverse events. The odds ratio for combination anti-anaerobic therapy was calculated for metronidazole and clindamycin. The appropriateness of combination anaerobic coverage therapy was evaluated based on expert opinion and guideline statements. The frequency of potential complications such as adverse drug events, Clostridium difficile infection, other diarrheal illness and superinfections associated with enteric organisms within 30 days after starting anaerobic therapy will be reported Main Results: In Progress Conclusion: To be determined