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MAKING ANTIBIOTIC DAYS OF TREATMENT ESTIMATION HAPPEN IN UNCOOPERATIVE SYSTEMS: TURNING ROUTINE DATA INTO STEWARDSHIP METRICS

European Statement

Clinical Pharmacy Services

Author(s)

Héctor Rodríguez-Ramallo, Nerea Báez-Gutiérrez, Alicia Melgar-Sánchez, José María Pastor-Martínez, Marta GÓNZALEZ-MARTÍNEZ, Jesus Francisco SIERRA-SÁNCHEZ.

Why was it done?

We designed and implemented a semi-automated method to estimate Days of Therapy for inpatient antibiotic use by leveraging routinely available Athos Prisma prescription exports. The workflow extracts daily prescription data and processes it with an automated script (Stata/Python/R) to generate DOT by antibiotic and hospital unit.

What was done?

DOT is a widely accepted measure of antibiotic exposure, and it is especially useful in paediatrics, where Defined Daily Doses (DDD) are unreliable due to weight variation across ages and heterogeneous “standard” dosing across centres.
Aim: to enable reliable, reproducible DOT measurement from data already available to all Athos Prisma users, facilitating stewardship dashboards and unit-level benchmarking.

How was it done?

Baseline capability: Athos Prisma supports DDD estimation but not DOT.
Data discovery: We identified a standard, centre-agnostic daily prescription export that contains the fields needed to compute DOT.
Processing pipeline: A one-click script parses the daily file, standardises drug names, groups by patient/day, and outputs DOT by antibiotic and unit.
Obstacles & solutions:
• DOT function is not integrated in Athos Prisma → built an external script that any site can run.
• Manual file export burden → consolidated to a single daily export; runtime <1 minute.
• Availability: The code is available on request and can be used by any Athos Prisma-using unit after minor local configuration.

What has been achieved?

We achieved a working code pipeline and measured DOT from June–September 2025 across the hospital. Highlights below:
Antibiotic DOTs Share of total DOT (%)
Amoxicillin/clavulanic 2608 9%
Ceftriaxone 4033 14%
Cefepime 611 2%
Piperacillin 3507 13%
Meropenem 1858 7%
Ciprofloxacin 970 3%
Levofloxacin 1495 5%
Cotrimoxazole 2443 9%
Cloxacillin 207 1%
Cefazolin 993 4%
Linezolid 751 3%
Daptomycin 678 2%

What next?

• Normalize to DOT per 100 patient-days at hospital and unit level.
• Automate the export (scheduled job) and publish weekly dashboards to stewardship teams.
• Set guardrails: prospective alerts for sustained increases in broad-spectrum DOT.
• Validate against a manual audit sample and report inter-method agreement.
• Share pack: provide a turnkey bundle to other centres.

ADDRESSING THE PROBLEM OF IMMUNOGLOBULIN SHORTAGES FROM A MULTIDISCIPLINARY POINT OF VIEW THROUGH THE CREATION OF A CLINICAL ADVISORY COMMISSION

European Statement

Selection, Procurement and Distribution

Why was it done?

Immunoglobulins are currently used both for the indications included in the SmPC and for other indications with different degrees of evidence and priority. Nonspecific immunoglobulins are blood products obtained by fractionation of plasma. During the Covid 19 pandemic there has been a decrease in donations and therefore a decrease in reserves in blood banks, which has generated a general shortage of immunoglobulins.

What was done?

Creation of a multidisciplinary advisory commission for the evaluation and optimization of the use of immunoglobulins in the current situation of shortage.

How was it done?

A multidisciplinary commission was created made up of a pharmacist, a hematologist, and other specialists involved in the immunoglobulin prescription circuit. Chronic treatments with nonspecific immunoglobulins active between April and June 2021 were evaluated, an immunoglobulin use guide was developed prioritizing those indications with grade of evidence Ia, Ib and IIa and urgency of type A or B(solid evidence and absence of alternatives with equal efficacy)for both chronic and acute treatments. In addition, an emergency stock was established for acute pathology

What has been achieved?

After the intervention, the following were included in the guide for the use of immunoglobulins as priority indications: primary immunodeficiencies, Kawasaki disease (Ia, A), Guillain Barré (Ib, B), Multifocal Motor Neuropathy(Ib, A), Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) )(Ia, A), Idiopathic Thrombocytopenic Purpura(ITP)(Ia, A),Secondary immunodeficiencies(Ib, A)with severe or recurrent infections, ineffective antimicrobial treatment, proven failure of specific antibodies and / or serum IgG level <4 gr / l. During the quarter prior to the creation of the commission, 31 patients were treated with immunoglobulins, 77.42% of whom were chronic; the most common indication was secondary immunodeficiency, 41.93%. Total immunoglobulin expenditure in this quarter (from April to June 2021) was 3,075g(mean: 99.2g / patient), with a cost of €15,925.98. While in the following trimester (post intervention)11 patients were treated, 72.73% being chronic, the most common indication was secondary immunodeficiency 36.36%. Total immunoglobulin expenditure in this quarter(from July to September 2021)was 660g (mean: 60g/patient), at a cost of €42,664.05

What next?

Carry out periodic control of active chronic treatments and assessment of the initiation of treatment according to the guidelines established by the Commission