NDLI: Implementation of treatment guidelines to support judicious use of antibiotic therapy.

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Implementation of treatment guidelines to support judicious use of antibiotic therapy.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Deuster, S. Roten, I. Muehlebach, S.
Spatial Coverage	Switzerland
Description	Country affiliation: Switzerland Author Affiliation: Deuster S ( Division of Pharmacy, University Hospital Basel, Basel, Switzerland. sdeuster@uhbs.ch)
Abstract	BACKGROUND AND OBJECTIVE: Judicious use of antibiotics is essential considering the growth of antimicrobial resistance and escalating costs in health care. This intervention study used treatment guidelines to improve antibiotic therapy by changing prescribing practice. METHODS: A before-after intervention study was performed in a 550-bed tertiary care teaching hospital in Switzerland, with an additional follow-up analysis 1 year later. The pre-intervention phase included chart analysis of current antibiotic use in 100 consecutive patients from the representative medical and surgical wards included in the study. Treatment guidelines were defined, taking into account published guidelines, the local antibacterial sensitivity of the pathogens, and the hospital antibiotic formulary defined by the drug and therapeutics committee. The guidelines were presented to the medical residents on a pocket card. They were informed and educated by the pharmacist (intervention). In the post-intervention phase immediately after the instruction, and in the follow-up phase 1 year later, a prospective analysis of antibiotic prescription was performed by chart review of 100 antibacterial treatments in consecutive patients to detect changes in antibiotic prescribing (treatment) and to determine whether these changes were sustained. RESULTS: The pre-intervention review of antibiotic use showed the need for therapy improvements in urinary tract infections (UTI) and hospital-acquired pneumonia (HAP). In the post-intervention phase 100% of UTI were treated as recommended, compared to 30% before the intervention (P < 0.001). The follow-up analysis showed a decrease in guideline adherence to 39% in patients with UTI. Before implementation of the clinical guidelines, HAP was inappropriately treated like community-acquired pneumonia (CAP). Immediately after the intervention, 50% of HAP patients were treated as recommended, and 1 year later (follow-up phase) 56% of HAP patients received the recommended antibiotic medication. This change in prescription practice was significant (P < 0.05). CONCLUSION: Antibiotic treatment guidelines for the infections most commonly occurring in hospitalized patients resulted in a significant increase in appropriate antibiotic use. The program was successful in changing prescription practice and achieved a sustained optimization of HAP therapy. Implementing, teaching and monitoring treatment guidelines can have a major impact on patient care.
File Format	HTM / HTML
ISSN	02694727
Issue Number	1
Volume Number	35
e-ISSN	13652710
Journal	Journal of Clinical Pharmacy and Therapeutics
Language	English
Publisher	Wiley-Blackwell
Publisher Date	2010-02-01
Publisher Place	Great Britain (UK)
Access Restriction	Subscribed
Subject Keyword	Discipline Therapeutics Discipline Pharmacology Anti-bacterial Agents Therapeutic Use Drug Utilization Statistics & Numerical Data Guideline Adherence Physician's Practice Patterns Adolescent Adult Aged Aged, 80 And Over Cross Infection Drug Therapy Female Formularies, Hospital Hospitals, Teaching Humans Male Medical Records Medical Staff, Hospital Education Middle Aged Pneumonia, Bacterial Practice Guidelines As Topic Switzerland Urinary Tract Infections Young Adult Journal Article
Content Type	Text
Resource Type	Article
Subject	Pharmacology Pharmacology (medical)

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