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Striking a Balance: The Cost of Antibiotic Waste and Its Impact on Pediatric Healthcare Systems

A two-year-long study conducted by Children’s Healthcare of Atlanta, a pediatric health care system incorporating three hospitals and over 600 total beds, has uncovered an alarming figure – the provider has accounted for an excess of $250,000 in antibiotic waste. At the forefront of this issue were discarded antibiotics, tallied at a cost of over $230,000. The findings were published in the reputable journal – Infection Control & Hospital Epidemiology.

The financial impact of this waste has instigated an urgent call for optimization within the healthcare system’s antibiotics related operations. Preeti Jaggi, MD, the director of the antimicrobial stewardship at this healthcare system, and also the co-author of the study, is at the helm of these optimization efforts.

The primary consequence of these findings is the realization that there is a need for precise and judicious utilization of antibiotics. The challenge is underlined by the intricacies of pediatric hospitals where weight-based dosing and the time between drug order and preparation by the pharmacy pose further obstacles.

There’s a silver lining, however. The aforementioned study has furnished opportunities to imbibe some crucial quality initiatives, for instance, undertaking measures to avoid extending hospital stays for patients beyond necessity. Implementing such initiatives is expected to bring about a positive effect on antibiotic prescription practices.

Upon executing a comprehensive review of data spanning 2020 and 2021, the researching team discovered a colossal wastage of 58,607 antibiotic doses – a daily average of approximately 80 doses. The most discarded drug from the tally was ampicillin, constituting 7,789 wasted doses. The majority (over 99%) of the wasted doses were intravenous (IV) or suspension formulations, with the rest being tablets.

Furthermore, half of this waste transpired in the initial two days of patient admission or on the day of discharge. In response to these unsettling findings, Children’s Healthcare of Atlanta has introduced automatic stop times for antibiotics. This has been instrumental in eliminating the pharmacy’s need to prepare unnecessary doses and is deemed a step towards the healthcare system becoming more conservatively efficient.

Future modifications are in discussion, to further extend the system’s potency to control avoidable waste. Proposed strategies include earlier discharge planning and encouraging physicians to consider the switch to oral therapy at an earlier stage for relevant patients.

Despite the measures put in place, the problem isn’t entirely licked. A considerable challenge is the quantity of the antibiotic waste production at the outpatient level due to overgenerous bottle sizes, releasing more drug than necessary for patient requirements.

Beyond the direct financial and patient care consequences, there is a silent but looming environmental concern. The surplus antibiotics production and disposal process require considerable energy, thereby contributing to the healthcare system’s carbon emissions footprint.

Hence, it becomes more imperative for the U.S. healthcare system to detect and curtail unnecessary waste, a not-so-obvious contributor to the country’s total carbon emissions. Measures and protocols implemented at Children’s Healthcare of Atlanta highlight the need for a balance between providing the best patient care and the accompanying financial and environmental implications of the processes involved.


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