Late delivery of antibiotics: a new proxy for antimicrobial stewardship?

Emmanuel Piednoir; Pascal Thibon; Elise Fiaux; Sebastien Cabon; Renaud Verdon; Pierre Tattevin

doi:10.1016/j.cmi.2023.12.029

Late delivery of antibiotics: a new proxy for antimicrobial stewardship?

Clin Microbiol Infect. 2024 Jan 4:S1198-743X(24)00002-8. doi: 10.1016/j.cmi.2023.12.029. Online ahead of print.

Authors

Emmanuel Piednoir¹, Pascal Thibon², Elise Fiaux³, Sebastien Cabon⁴, Renaud Verdon⁵, Pierre Tattevin⁶

Affiliations

¹ INSERM UMR_S1311, Universite de Caen Normandie, Caen, France. Electronic address: emmanuel.piednoir@ch-ag.fr.
² Statistic Department, Normantibio Regional Centre for Antibiotic Stewardship, Normandy, France.
³ Centre for Antibiotic Stewardship, University Hospital Centre Rouen, Normantibio Regional, Normandy, France.
⁴ Direction Departermentale de l'Assurance Maladie, Direction des Finances, Paris, France.
⁵ INSERM UMR_S1311, Universite de Caen Normandie, Caen, France; CHU de Caen, Infectious Diseases, Normandy, France.
⁶ Infectious Diseases Unit, Pontchaillou University Hospital, Rennes, France.

PMID: 38184295
DOI: 10.1016/j.cmi.2023.12.029

Abstract

Objectives: To analyse the time elapsed between the prescription of antibiotics and their pick-up at the pharmacy and identify their determinants.

Methods: We used the National Health Insurance reimbursement databases on antibiotics delivery in 2021 in La Manche, Western France. Delayed delivery was defined as the time between prescription and antibiotic pick-up of >24 hours.

Results: We enrolled 207 250 prescriptions, of whom 18 728 (9.0%) collected their antibiotics at the community pharmacy >24 hours after prescription. Independent factors associated with delayed delivery were age >15 years (15-64 years: OR, 2.08 [1.98-2.19]; p < 0.001 and >65 years OR, 3.27 [3.09-3.46]; p < 0.001), male sex (OR, 00.77 [0.75-0.80]; p < 0.001), low income (OR, 1.08 [1.02-1.15]; p = 0.013), chronic diseases (OR, 1.29 [1.25-1.34]; p < 0.001), prescription during the weekend (OR, 1.49 [1.43-1.56]; p < 0.001), summer season (OR, 1.11 [1.07-1.16]; p < 0.001), lock-down period (OR, 4.15 [3.80-4.53]; p < 0.001), and distance from the patient home to his general practitioner office and the pharmacy >10 km (OR, 1.17 [1.13-1.21]; p < 0.001).

Discussion: The delayed delivery of antibiotics after prescription is not uncommon, especially in elderly patients, those with low income or chronic diseases, in case of weekend prescriptions, summer season and when the pharmacy is > 10 km away from the patient's home and his general practitioner office. If confirmed, this potential indicator of unnecessary prescriptions, readily available in some databases, may be used to target antimicrobial stewardship programmes and monitor the effect of interventions.

Keywords: Antibiotic delivery; Antimicrobial stewardship; Prevalence; Proxy; Risk factors.