SMART-CAZ/AVI: algorithm to guide pharmaceutical clinical reasoning in managing the rational use of ceftazidime/avibactam in adult patients
DOI:
https://doi.org/10.30968/jhphs.2025.164.1286Abstract
Objectives: Develop and evaluate the application of SMART-CAZ/AVI, an algorithm designed to guide the clinical pharmacist’s role in managing the use of ceftazidime/avibactam (CAZ/AVI). The algorithm supports pharmaceutical monitoring as a clinical decision-support tool, facilitating the identification of opportunities to optimize antibiotic therapy and ensuring the rational use of CAZ/AVI. Methods: The Stewardship & Monitoring Algorithm for Rational Therapy (SMART) model was developed based on antimicrobial stewardship principles and divided into three sections: Initial Pharmaceutical Assessment, Microbiology, and Time-Out. SMART-CAZ/AVI refers to the application of the SMART model to the pharmaceutical assessment of CAZ/AVI in adult patients. Each section contains specific questions and guidelines to direct the clinical pharmacist’s role in ensuring effective and safe antibiotic therapy. The analysis of the algorithm’s application was conducted retrospectively and descriptively, using data collected before and after the implementation of SMART-CAZ/AVI in a private hospital in Rio de Janeiro, from January 2023 to September 2024. The data were divided into three 7-month periods: pre-implementation, immediate post-implementation, and late post-implementation. Results: A total of 93 Time-Outs and 23 pharmaceutical interventions were recorded, with overdosing based on creatinine clearance (ClCr) being the most frequent issue (68.4%). The analysis between the immediate and late post-implementation periods revealed a 55.2% reduction in overdose interventions and the elimination of administration scheduling errors; however, prolonged antibiotic therapy increased by 300%. The percentage of treatments without formal indication increased by 108.33%, and the analysis of the mean days of therapy (DOT) showed an initial reduction of 64.15% in the immediate period, followed by a late increase of 242.11%. Conclusion: SMART-CAZ/AVI has the potential to become an essential tool to support clinical pharmacists in managing CAZ/AVI use, identifying key issues in antimicrobial therapy. Its implementation directly contributed to reducing overdose and administration errors. SMART-CAZ/AVI may be established as a standardized tool to streamline pharmaceutical monitoring in hospitals, ensuring effective and safe antibiotic therapy.
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