Intervention to improve antibiotic prescribing practices for hospital inpatients
Systematic review
Abstract:
This Cochrane review looks at the effectiveness of professional interventions that alone or in combination are successful in promoting prudent antibiotic prescribing to hospital inpatients and evaluates the impact these interventions have on reducing the incidence of antimicrobial resistant pathogens or CDAD and the impact on clinical outcomes. To determine what improved prescribing, 66 studies were analysed from North America and the United Kingdom. · Six studies tested methods increasing antibiotics around time of surgery · The other sixty studies tested persuasive and restrictive methods to reduce unnecessary antibiotic usage Conclusions were that both methods improved prescribing, decreased infection rates, deaths, illness and length of stay but that restrictive methods appeared to have a greater effect than persuasive methods
Category:
Control
Investigation
Management
Prevention
Treatment
Expert Review
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Summary:
The review looks at the effectiveness of professional interventions that alone or in combination are successful in promoting prudent antibiotic prescribing to hospital inpatients and evaluates the impact these interventions have on reducing the incidence of antimicrobial resistant pathogens or CDAD and the impact on clinical outcomes. To determine what improved prescribing, 66 studies were analysed from North America and the United Kingdom.· Six studies tested methods increasing antibiotics around time of surgery· The other sixty studies tested persuasive and restrictive methods to reduce unnecessary antibiotic usageConclusions were that both methods improved prescribing, decreased infection rates, deaths, illness and length of stay but that restrictive methods appeared to have a greater effect than persuasive methods
Questions Addressed:
The review looks at how antibiotics prescribing by physicians working in hospitals can be improved in an attempt to reduce antimicrobial resistance and CDAD
Type of Study:
Systematic review
Methods Valid:
Yes
Methods Valid Detail:
Up to 50% of antibiotic usage in hospitals is inappropriate – the review is an attempt at improving how antibiotics are prescribed
Results Reliability:
Yes: Searches undertaken from EPOC, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE (1980-2003) additional studies from bibliographies of retrieved articles
Problems or Biases:
More studies are needed to assess the clinical benefits of the two main methods reviewed.
Relevant Studies:
Keywords:
antibiotic prescribing Clostridium difficile clostridium difficile associated diarrhoea (CDAD) hospital acquired infection antimicrobial resistance
Reviewer Name:
Sue Wiseman
Reviewer Post:
Nurse Consultant –Infection Control, DH
Reviewer Affiliations:
Member Advisory Committee on Dangerous Pathogens Health Protection Adviser Royal College of Nursing P/T Member Infection Control Nurses Association