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A survey was conducted among first-year pharmacy students at Howard University College of Pharmacy to measure their level of knowledge and gauge their opinion regarding the off-label uses of two non-steroidal anti-inflammatory drugs (NSAIDs), indomethacin and celecoxib. The average level of knowledge on indomethacin and celecoxib was 36.2% and 31.2%, respectively. Among the five knowledge-based questions on each of these drugs, the highest correct response rate was obtained on indomethacin dosing at 72.9%, and 64.7% on the class of drugs celecoxib belongs to. In the responses to questions on indomethacin, the highest correct response of 72.9% was significantly higher (pp=0.3257). In the same manner, the correct response rate of 64.7% for the class of drugs that celecoxib belongs to was significantly higher than the response rates for the other questions (pp=0.0883). The opinions of the students varied, with a majority (55.9%) agreeing that serious diseases should be treated with non-approved medications. In the case of indomethacin, 35.5% of the respondents believed that because of toxicity issues, it should not be used outside the approved indications, while 27.8% believed that the safety has been established and can be used outside the approved use. Most respondents (55.9%) on celecoxib thought colorectal cancer is a serious disease and can be treated with non-approved drugs.

Background Per World Health Organization, carbapenems should be key targets for antibiotic stewardship programs. Methods A multifaceted antimicrobial stewardship program (ASP) was implemented in January 2018 at a 160-bed tertiary care center serving the tristate area of Iowa, South Dakota and Nebraska. Carbapenem use during pre ASP intervention period (P1: 07/01/2016-12/31/2017) was compared with ASP intervention period (P2: 01/01/2018-06/30/2019). ASP interventions included: providing educational pearls in monthly physician newsletter; educational posters in high-traffic provider areas; suppression of carbapenem results on microbiology susceptibility reports; distributing monthly carbapenem use data to providers; provider counseling for appropriate ordering; creating carbapenem alternative alert in order-entry software; generating pharmacy decision-support software algorithms to aid in identifying intervention opportunities; removing carbapenems from order-sets where appropriate. Additional ASP pharmacist interventions: limiting double antibiotic coverage for pseudomonas/anaerobes; de-escalation recommendations. Results Carbapenem use declined significantly from a mean of 64.81 days of therapy (DOT) per 1000 patient days during P1 to 8.91 DOT per 1000 patient days in P2 (p< 0.001). All hospital units showed a significant decrease in carbapenem use, with intensive care step-down unit noting 85.7% reduction (p < 0.00001); floors (medicine, pediatric, surgery) with 61.6% reduction (p< 0.00001); and intensive care units with 52% reduction (p< 0.00001) during P2 compared to P1. Defined daily doses per 1000 patient days decreased from 314.9 in P1 to 93.4 in P2 (p< 0.00001). During P2, 58.3% (132/228) of carbapenem orders were found to be appropriate compared to 37.5% (190/506) in P1 (p< 0.00001). Sensitivity profile for Pseudomonas aeruginosa improved from 86% carbapenem sensitivity during P1 to 89% in P2. No Carbapenem Resistant Enterobacteriaceae isolates were identified. Cost savings of $643 per 1000 patient days were recognized in P2 as a result of reduced carbapenem use. Conclusion There was a significant decline in total carbapenem utilization, an increase in proportion of appropriate use and considerable cost savings as a result of ASP interventions. Disclosures All Authors: No reported disclosures