Pharmacist-led two-dose cefepime protocol a boon for ED patients with sepsis

Implementing a pharmacist-driven protocol of second-dose cefepime results in a lower duration between second-dose antibiotics, days requiring vasopressors, and a slight decrease in length of hospital stay among adult patients with sepsis in the emergency department (ED), according to a study.

Researchers conducted this retrospective, single-centre, pre-post observational cohort study, with approval from the institutional review board. 

The main outcome was a reduction in time between the first and the second antibiotic doses of sepsis patients in the ED. Other outcomes were length of vasopressor therapy, intensive care unit (ICU) length of stay, hospital length of stay, duration of mechanical ventilation, and mortality.

Of the eligible patients, 84 were included in the pharmacist-led two-dose hospital protocol and 79 in the historical control. The median time between the first and second dose of antibiotics was 12 hours in the control cohort versus 8.5 hours in the tested cohort.

Furthermore, the average time requiring vasopressor therapy was 1.20 days for the control cohort and 0.46 days for the postimplementation group, while the median hospital stay was 8 and 7 days for the control and tested cohorts, respectively.

“Prior literature evaluating the importance of timely second-dose antibiotics in patients with sepsis has led to better outcomes and a possible reduction in mortality, length of mechanical ventilation, and length of time requiring vasopressors,” the researchers said.