David Sudekum, PharmD, BCPS
Clinical Pharmacy Specialist, Medical Critical Care
Saint Joseph Mercy Health System, United States
Disclosure information not submitted.
Sarah Kean, PharmD
Clinical Pharmacy Specialist, Internal Medicine
St. Joseph Mercy Health System, United States
Disclosure information not submitted.
Title: Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal in the Inpatient Setting
INTRODUCTION
Benzodiazepines are currently the agents of choice for treatment of alcohol withdrawal syndrome (AWS). Phenobarbital may be a more effective and safer alternative for use in this patient population in the inpatient setting.
METHODS
This is a retrospective, multi-center, cohort study evaluating patient data from 23 hospitals in the Trinity Health System during the 2019 calendar year. Patients were included if they were at least 18 years of age, admitted with a diagnosis of AWS, and given at least one dose of a benzodiazepine or phenobarbital. Patients were excluded if they died within 24 hours of presentation, were pregnant, had a listed allergy to phenobarbital or a benzodiazepine, or were on a benzodiazepine or phenobarbital prior to admission. Patients who received both phenobarbital and a benzodiazepine were included in the phenobarbital group. The primary outcome was incidence of mechanical ventilation. Secondary outcomes included duration of mechanical ventilation, hospital length of stay, incidence of ICU admission, incidence of seizure, incidence of delirium, and incidence of ventilator-associated pneumonia.
RESULTS
A total of 3,070 patients were included in the study (2749 in the benzodiazepine cohort and 321 in the phenobarbital cohort). There was no statistically significant difference between cohorts with incidence of mechanical ventilation (2.02% versus 2.41%, P=0.605). The phenobarbital group had a significantly higher proportion of patients with ICU admission (31.17% versus 10.33%, P< 0.001), a higher average length of stay (6.55 days versus 5.44 days, P=0.004), and received more doses on average of benzodiazepines (19.65 versus 12.66, P< 0.001).
CONCLUSION
This study suggests that even with a higher proportion of ICU patients and more cumulative doses of benzodiazepines, AWS patients receiving phenobarbital were not at increased risk of mechanical ventilation. Larger scale, well-executed, and adequately powered studies are needed to confirm these findings.