Interventions to improve antibiotic prescribing practices for hospital inpatients

Peter Davey, Erwin Brown, Lynda Fenelon, Roger Finch, Ian Gould, Giles Hartman, Alison Holmes, Craig Ramsay, Eric Taylor, Mark Wilcox, Philip J. Wiffen

    Research output: Contribution to journalReview article

    448 Citations (Scopus)

    Abstract

    Background Up to 50% of antibiotic usage in hospitals is inappropriate. In hospitals infections caused by antibiotic-resistant bacteria are associated with higher mortality, morbidity and prolonged hospital stay compared with infections caused by antibiotic-susceptible bacteria. Clostridium difficile associated diarrhoea (CDAD) is a hospital acquired infection that is caused by antibiotic prescribing.

    Objectives To estimate the effectiveness of professional interventions that alone, or in combination, are effective in promoting prudent antibiotic prescribing to hospital inpatients, to evaluate the impact of these interventions on reducing the incidence of antimicrobial resistant pathogens or CDAD and their impact on clinical outcome.

    Search strategy We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialized register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE from 1980 to November 2003. Additional studies were obtained from the bibliographies of retrieved articles

    Selection criteria We included all randomised and controlled clinical trials (RCT/CCT), controlled before and after studies (CBA) and interrupted time series (ITS) studies of antibiotic prescribing to hospital inpatients. Interventions included any professional or structural interventions as defined by EPOC.

    Data collection and analysis Two reviewers extracted data and assessed quality.

    Main results Sixty six studies were included and 51 (77%) showed a significant improvement in at least one outcome. Six interventions only aimed to increase treatment, 57 interventions aimed to decrease treatment and three interventions aimed to both increase and decrease treatment. The intervention target was the decision to prescribe antibiotics (one study), timing of first dose (six studies), the regimen (drug, dosing interval etc, 61 studies) or the duration of treatment (10 studies); 12 studies had more than one target. Of the six interventions that aimed to increase treatment, five reported a significant improvement in drug outcomes and one a significant improvement in clinical outcome. Of the 60 interventions that aimed to decrease treatment 47 reported drug outcomes of which 38 (81%) significantly improved, 16 reported microbiological outcomes of which 12 (75%) significantly improved and nine reported clinical outcomes of which two (22%) significantly deteriorated and 3 (33%) significantly improved. Five studies aimed to reduce CDAD. Three showed a significant reduction in CDAD. Due todifferences in study design and duration of follow up it was only possible to perform meta-regression on a few studies.

    Authors' conclusions The results show that interventions to improve antibiotic prescribing to hospital inpatients are successful, and can reduce antimicrobial resistance or hospital acquired infections.

    Original languageEnglish
    Article numberCD003543
    Pages (from-to)-
    Number of pages90
    JournalCochrane Database of Systematic Reviews
    Issue number4
    DOIs
    Publication statusPublished - 2005

    Cite this

    Davey, Peter ; Brown, Erwin ; Fenelon, Lynda ; Finch, Roger ; Gould, Ian ; Hartman, Giles ; Holmes, Alison ; Ramsay, Craig ; Taylor, Eric ; Wilcox, Mark ; Wiffen, Philip J. / Interventions to improve antibiotic prescribing practices for hospital inpatients. In: Cochrane Database of Systematic Reviews. 2005 ; No. 4. pp. -.
    @article{283f54fcb98a42aea7d7914b159a321c,
    title = "Interventions to improve antibiotic prescribing practices for hospital inpatients",
    abstract = "Background Up to 50{\%} of antibiotic usage in hospitals is inappropriate. In hospitals infections caused by antibiotic-resistant bacteria are associated with higher mortality, morbidity and prolonged hospital stay compared with infections caused by antibiotic-susceptible bacteria. Clostridium difficile associated diarrhoea (CDAD) is a hospital acquired infection that is caused by antibiotic prescribing.Objectives To estimate the effectiveness of professional interventions that alone, or in combination, are effective in promoting prudent antibiotic prescribing to hospital inpatients, to evaluate the impact of these interventions on reducing the incidence of antimicrobial resistant pathogens or CDAD and their impact on clinical outcome.Search strategy We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialized register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE from 1980 to November 2003. Additional studies were obtained from the bibliographies of retrieved articlesSelection criteria We included all randomised and controlled clinical trials (RCT/CCT), controlled before and after studies (CBA) and interrupted time series (ITS) studies of antibiotic prescribing to hospital inpatients. Interventions included any professional or structural interventions as defined by EPOC.Data collection and analysis Two reviewers extracted data and assessed quality.Main results Sixty six studies were included and 51 (77{\%}) showed a significant improvement in at least one outcome. Six interventions only aimed to increase treatment, 57 interventions aimed to decrease treatment and three interventions aimed to both increase and decrease treatment. The intervention target was the decision to prescribe antibiotics (one study), timing of first dose (six studies), the regimen (drug, dosing interval etc, 61 studies) or the duration of treatment (10 studies); 12 studies had more than one target. Of the six interventions that aimed to increase treatment, five reported a significant improvement in drug outcomes and one a significant improvement in clinical outcome. Of the 60 interventions that aimed to decrease treatment 47 reported drug outcomes of which 38 (81{\%}) significantly improved, 16 reported microbiological outcomes of which 12 (75{\%}) significantly improved and nine reported clinical outcomes of which two (22{\%}) significantly deteriorated and 3 (33{\%}) significantly improved. Five studies aimed to reduce CDAD. Three showed a significant reduction in CDAD. Due todifferences in study design and duration of follow up it was only possible to perform meta-regression on a few studies.Authors' conclusions The results show that interventions to improve antibiotic prescribing to hospital inpatients are successful, and can reduce antimicrobial resistance or hospital acquired infections.",
    author = "Peter Davey and Erwin Brown and Lynda Fenelon and Roger Finch and Ian Gould and Giles Hartman and Alison Holmes and Craig Ramsay and Eric Taylor and Mark Wilcox and Wiffen, {Philip J.}",
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    Davey, P, Brown, E, Fenelon, L, Finch, R, Gould, I, Hartman, G, Holmes, A, Ramsay, C, Taylor, E, Wilcox, M & Wiffen, PJ 2005, 'Interventions to improve antibiotic prescribing practices for hospital inpatients', Cochrane Database of Systematic Reviews, no. 4, CD003543, pp. -. https://doi.org/10.1002/14651858.CD003543.pub2

    Interventions to improve antibiotic prescribing practices for hospital inpatients. / Davey, Peter; Brown, Erwin; Fenelon, Lynda; Finch, Roger; Gould, Ian; Hartman, Giles; Holmes, Alison; Ramsay, Craig; Taylor, Eric; Wilcox, Mark; Wiffen, Philip J.

    In: Cochrane Database of Systematic Reviews, No. 4, CD003543, 2005, p. -.

    Research output: Contribution to journalReview article

    TY - JOUR

    T1 - Interventions to improve antibiotic prescribing practices for hospital inpatients

    AU - Davey, Peter

    AU - Brown, Erwin

    AU - Fenelon, Lynda

    AU - Finch, Roger

    AU - Gould, Ian

    AU - Hartman, Giles

    AU - Holmes, Alison

    AU - Ramsay, Craig

    AU - Taylor, Eric

    AU - Wilcox, Mark

    AU - Wiffen, Philip J.

    PY - 2005

    Y1 - 2005

    N2 - Background Up to 50% of antibiotic usage in hospitals is inappropriate. In hospitals infections caused by antibiotic-resistant bacteria are associated with higher mortality, morbidity and prolonged hospital stay compared with infections caused by antibiotic-susceptible bacteria. Clostridium difficile associated diarrhoea (CDAD) is a hospital acquired infection that is caused by antibiotic prescribing.Objectives To estimate the effectiveness of professional interventions that alone, or in combination, are effective in promoting prudent antibiotic prescribing to hospital inpatients, to evaluate the impact of these interventions on reducing the incidence of antimicrobial resistant pathogens or CDAD and their impact on clinical outcome.Search strategy We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialized register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE from 1980 to November 2003. Additional studies were obtained from the bibliographies of retrieved articlesSelection criteria We included all randomised and controlled clinical trials (RCT/CCT), controlled before and after studies (CBA) and interrupted time series (ITS) studies of antibiotic prescribing to hospital inpatients. Interventions included any professional or structural interventions as defined by EPOC.Data collection and analysis Two reviewers extracted data and assessed quality.Main results Sixty six studies were included and 51 (77%) showed a significant improvement in at least one outcome. Six interventions only aimed to increase treatment, 57 interventions aimed to decrease treatment and three interventions aimed to both increase and decrease treatment. The intervention target was the decision to prescribe antibiotics (one study), timing of first dose (six studies), the regimen (drug, dosing interval etc, 61 studies) or the duration of treatment (10 studies); 12 studies had more than one target. Of the six interventions that aimed to increase treatment, five reported a significant improvement in drug outcomes and one a significant improvement in clinical outcome. Of the 60 interventions that aimed to decrease treatment 47 reported drug outcomes of which 38 (81%) significantly improved, 16 reported microbiological outcomes of which 12 (75%) significantly improved and nine reported clinical outcomes of which two (22%) significantly deteriorated and 3 (33%) significantly improved. Five studies aimed to reduce CDAD. Three showed a significant reduction in CDAD. Due todifferences in study design and duration of follow up it was only possible to perform meta-regression on a few studies.Authors' conclusions The results show that interventions to improve antibiotic prescribing to hospital inpatients are successful, and can reduce antimicrobial resistance or hospital acquired infections.

    AB - Background Up to 50% of antibiotic usage in hospitals is inappropriate. In hospitals infections caused by antibiotic-resistant bacteria are associated with higher mortality, morbidity and prolonged hospital stay compared with infections caused by antibiotic-susceptible bacteria. Clostridium difficile associated diarrhoea (CDAD) is a hospital acquired infection that is caused by antibiotic prescribing.Objectives To estimate the effectiveness of professional interventions that alone, or in combination, are effective in promoting prudent antibiotic prescribing to hospital inpatients, to evaluate the impact of these interventions on reducing the incidence of antimicrobial resistant pathogens or CDAD and their impact on clinical outcome.Search strategy We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialized register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE from 1980 to November 2003. Additional studies were obtained from the bibliographies of retrieved articlesSelection criteria We included all randomised and controlled clinical trials (RCT/CCT), controlled before and after studies (CBA) and interrupted time series (ITS) studies of antibiotic prescribing to hospital inpatients. Interventions included any professional or structural interventions as defined by EPOC.Data collection and analysis Two reviewers extracted data and assessed quality.Main results Sixty six studies were included and 51 (77%) showed a significant improvement in at least one outcome. Six interventions only aimed to increase treatment, 57 interventions aimed to decrease treatment and three interventions aimed to both increase and decrease treatment. The intervention target was the decision to prescribe antibiotics (one study), timing of first dose (six studies), the regimen (drug, dosing interval etc, 61 studies) or the duration of treatment (10 studies); 12 studies had more than one target. Of the six interventions that aimed to increase treatment, five reported a significant improvement in drug outcomes and one a significant improvement in clinical outcome. Of the 60 interventions that aimed to decrease treatment 47 reported drug outcomes of which 38 (81%) significantly improved, 16 reported microbiological outcomes of which 12 (75%) significantly improved and nine reported clinical outcomes of which two (22%) significantly deteriorated and 3 (33%) significantly improved. Five studies aimed to reduce CDAD. Three showed a significant reduction in CDAD. Due todifferences in study design and duration of follow up it was only possible to perform meta-regression on a few studies.Authors' conclusions The results show that interventions to improve antibiotic prescribing to hospital inpatients are successful, and can reduce antimicrobial resistance or hospital acquired infections.

    U2 - 10.1002/14651858.CD003543.pub2

    DO - 10.1002/14651858.CD003543.pub2

    M3 - Review article

    SP - -

    JO - Cochrane Database of Systematic Reviews

    JF - Cochrane Database of Systematic Reviews

    SN - 1469-493X

    IS - 4

    M1 - CD003543

    ER -