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 journalArticle

488 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 methods

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 to differences 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
JournalCochrane Database of Systematic Reviews
Issue number4
DOIs
Publication statusPublished - 19 Oct 2005

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Inpatients
Anti-Bacterial Agents
Clostridium difficile
Diarrhea
Cross Infection
Therapeutics
Organizations
Pharmaceutical Preparations
Bacteria
Bibliography
MEDLINE
Length of Stay
Randomized Controlled Trials
Morbidity
Mortality
Incidence
Infection

Cite this

Davey, P., Brown, E., Fenelon, L., Finch, R., Gould, I., Hartman, G., ... Wiffen, P. J. (2005). Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database of Systematic Reviews, (4), [CD003543]. 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, 19.10.2005.

Research output: Contribution to journalArticle

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. https://doi.org/10.1002/14651858.CD003543.pub2
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.
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abstract = "BackgroundUp 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.ObjectivesTo 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 methodsWe 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 criteriaWe 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 analysisTwo reviewers extracted data and assessed quality.Main resultsSixty-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 to differences in study design and duration of follow up, it was only possible to perform meta-regression on a few studies.Authors' conclusionsThe results show that interventions to improve antibiotic prescribing to hospital inpatients are successful, and can reduce antimicrobial resistance or hospital acquired infections.",
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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

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N2 - BackgroundUp 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.ObjectivesTo 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 methodsWe 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 criteriaWe 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 analysisTwo reviewers extracted data and assessed quality.Main resultsSixty-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 to differences in study design and duration of follow up, it was only possible to perform meta-regression on a few studies.Authors' conclusionsThe results show that interventions to improve antibiotic prescribing to hospital inpatients are successful, and can reduce antimicrobial resistance or hospital acquired infections.

AB - BackgroundUp 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.ObjectivesTo 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 methodsWe 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 criteriaWe 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 analysisTwo reviewers extracted data and assessed quality.Main resultsSixty-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 to differences in study design and duration of follow up, it was only possible to perform meta-regression on a few studies.Authors' conclusionsThe results show that interventions to improve antibiotic prescribing to hospital inpatients are successful, and can reduce antimicrobial resistance or hospital acquired infections.

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DO - 10.1002/14651858.CD003543.pub2

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SN - 1469-493X

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