Meta-analyses show that restrictive and persuasive methods improve prescribing in hospital setting
TUESDAY, May 14 (HealthDay News) -- Both restrictive and persuasive measures can be effective for changing antibiotic prescribing behavior in a hospital setting, according to a review published online April 30 in The Cochrane Library.
To estimate the effectiveness of professional interventions that are effective in antibiotic stewardship for hospital inpatients, Peter Davey, M.D., from the University of Dundee in the United Kingdom, and colleagues reviewed the literature and identified 89 studies involving 95 interventions. They compared interventions with a restrictive element and those that were persuasive. Persuasive interventions relied on educational resources and outreach, reminders, or audit and feedback.
The researchers found that in 84 percent of the studies the intervention targeted the antibiotic (choice, timing of first dose, route of administration). The remaining interventions tried to alter patient exposure to antibiotics (decision to treat, duration of treatment). In a meta-analysis of 52 interrupted time series studies that compared restrictive versus persuasive interventions, restrictive interventions correlated with a significantly greater impact on prescribing outcomes at one month and on microbial outcomes at six months. The differences were not significant at 12 or 18 months. Reductions in Clostridium difficile and other bacterial infections were seen with interventions intended to decrease excessive prescribing. Four interventions intended to increase effective prescribing for pneumonia correlated with a significant reduction in mortality (risk ratio, 0.89). No significant increase in mortality was seen for nine interventions aimed at decreasing excessive prescribing.
"The results show that interventions to reduce excessive antibiotic prescribing to hospital inpatients can reduce antimicrobial resistance or hospital-acquired infections, and interventions to increase effective prescribing can improve clinical outcome," the authors write.
Abstract (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003543.pub3/abstract )Full Text (subscription or payment may be required) (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003543.pub3/full )