The Impact of Policy Guidelines on Hospital Antibiotic Use over a Decade: A Segmented Time Series Analysis (original) (raw)
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Improving antibiotic use: 25 years of antibiotic guidelines and related initiatives
Communicable diseases intelligence quarterly report, 2003
In the late 1970s concern in Melbourne teaching hospitals over the increasing incidence of antibiotic-resistant microorganisms and inappropriate antibiotic prescribing, led to the establishment of a working party to produce guidelines on appropriate antimicrobial therapy. Therapeutic Guidelines: Antibiotic is now produced, marketed and sold by Therapeutic Guidelines Limited, an independent, not-for-profit enterprise that distils best-practice prescribing guidelines for Australian health professionals. Therapeutic Guidelines now cover all major therapeutic areas. Mere distribution of the guidelines had little impact on prescribing habits. However, targeted education campaigns have helped to improve antibiotic prescribing. The Antibiotic title remains the flagship of Therapeutic Guidelines Limited with sales, surveys and endorsements over 11 editions attesting to its wide acceptance and use. Therapeutic Guidelines: Antibiotic is one of many initiatives that have contributed to improvi...
Longitudinal surveillance of antibiotic use in the hospital
QJM, 2001
We evaluated antimicrobial use in our hospital by department, including indications for use, source of infections, use of the microbiology laboratory, and appropriateness of prescribing, in a prospective, comparative, non-interventional study of all patients receiving antimicrobial agents. We excluded departments where antimicrobial use was negligible. The other 19 departments were followed for 3 (n = 4) or 4 (n=15) months, including 2 consecutive months in the spring-summer and either 1 or 2 in the autumn-winter. Antimicrobial therapy was followed from initiation, through possible adaptations, and possible change from intravenous to oral therapy, until discontinuation of treatment. Overall, 6376 antibiotics were given to 2306 patients. Of the surveyed hospitalized patients, 62%"22% received antibiotics, with a range of 4±100% per department. Antibiotics were prescribed for infections acquired in the community (3037 instances, 47%), in the hospital (2182, 34%), in a nursing home (575, 9%), and for prophylaxis continued post-operatively (582, 9%). The most common indications for antimicrobial use were: respiratory tract infection (1729, 27%), urinary tract infection (955, 15%), sepsis (701, 11%), intra-abdominal infections (663, 10%), prophylaxis 582 (9%), soft-tissue infection (572, 9%), and surgical site infection (319, 5%). Univariate indicators for appropriateness of treatment were: age, department, site of infection, source of infection, antimicrobial drug and serum creatinine (all p-0.001). Forty-nine antimicrobials were prescribed in 279 combinations, 58% as single agent and 42% as drug combinations. Half of all antimicrobial use consisted of four agents: cefuroxime (19.1%), metronidazole (11.3%), gentamicin (10.6%) and ampicillin (10.2%), which together accounted for 20% of expenditure on antibiotics. Although use of as many as 53% of antimicrobials (26/49) surveyed was restricted, use in this category accounted for only 29% of all antimicrobial courses. Of 6376 antibiotic courses, 4101 (64%) were given intravenously and 2275 (36%) orally. Appropriateness of use of restricted drugs was lower (70%) than of unrestricted ones (84%, p-0.001). Of 24 571 defined daily doses (DDD) given orally, 4587 (19%) were restricted, compared to 7264 (34%) of 21 602 DDDs given intravenously (p-0.001). Antibiotic treatment in our hospital appears to be substantial and increasing, justifying efforts to improve appropriateness of therapy and improve clinical and financial results.
Improving compliance with hospital antibiotic guidelines: a time-series intervention analysis
2005
Results: At baseline, compliance with the drug choice guidelines was 67%. The first intervention showed a significant change in the level of compliance of 115.5% (95% CI: 8%; 23%). AD did not lead to statistically significant additional changes in already high levels 112.5% (95% CI:-3%; 28%) of compliance. Post-intervention compliance was stable at 86%. Conclusions: Updating the guidelines in close
Active promotion of antibiotic guidelines: an intensive program
Communicable diseases intelligence quarterly report, 2003
John Hunter Hospital, a 600 bed tertiary referral centre, has an antimicrobial working party comprising representatives from pharmacy, microbiology and infectious diseases areas, which is responsible for the development, implementation and evaluation of guidelines for the appropriate use of antimicrobials. Activities include the development and promotion of a restricted antimicrobial policy, and specific guidelines for the management of pneumonia, and surgical prophylaxis and wound infection. These guidelines are available on the hospital intranet, in hard copies in all wards, and on laminated cards (10 x 6.5 cm) attached to the hospital identification tag. Active promotion of the guidelines is undertaken at orientation and via a 2 week intensive period four times per year (corresponding with the registrar rotation), weekly meetings and follow up of non-compliance courses directly with the attending medical officer. Education and feedback to specific groups is provided as required. ...
Estimating National Trends in Inpatient Antibiotic Use Among US Hospitals From 2006 to 2012
JAMA internal medicine, 2016
The rising threat of antibiotic resistance and other adverse consequences resulting from the misuse of antibiotics requires a better understanding of antibiotic use in hospitals in the United States. To use proprietary administrative data to estimate patterns of US inpatient antibiotic use in recent years. For this retrospective analysis, adult and pediatric in-patient antibiotic use data was obtained from the Truven Health MarketScan Hospital Drug Database (HDD) from January 1, 2006, to December 31, 2012. Data from adult and pediatric patients admitted to 1 of approximately 300 participating acute care hospitals provided antibiotic use data for over 34 million discharges representing 166 million patient-days. We retrospectively estimated the days of therapy (DOT) per 1000 patient-days and the proportion of hospital discharges in which a patient received at least 1 dose of an antibiotic during the hospital stay. We calculated measures of antibiotic usage stratified by antibiotic cla...
Turkish Journal of Pharmaceutical Sciences
INTRODUCTION: Antibiotic Resistance poses greater threat to the world. Irrational use of antibiotics is one major contributing factor for it. Evaluation of antimicrobial use with help of indicators and World Health Organization (WHO) classification of antibiotics as Access, Watch, and Reserve category. We aimed to evaluate the prescribing pattern of antibiotics using Access, Watch, and Reserve classification by World Health Organization and selected indicators for antimicrobial use in the hospitals. METHODS: 1000 prescriptions were analyzed during the study for antibiotic prescribing patterns. Antibiotic consumption was calculated using defined daily dose methodology. Prescribing pattern was evaluated using World Health Organization classification of antibiotics as Access, Watch, and Reserve category and using selected indicators (Hospital and Prescribing) for antimicrobial use in the hospitals. RESULTS: 1128 antibiotics were prescribed during the study.19-44 age group were prescribed with high number of antibiotics (n=510). Females were prescribed with high number of antibiotics (n=602). Azithromycin was most commonly consumed antibiotic (14.97 DDD/1000/day). Four antibiotics from Access category and five antibiotics from Watch category were prescribed in the study. Watch category of antibiotics were consumed high in number. There were no standard treatment guidelines in the hospital. 98.0% of antibiotics are consistent with the hospital formulary and prescribed in generic names. The average number of antibiotics prescribed was 1.12. The average duration of antimicrobial treatment was 5.24 days. The percentage of patients prescribed with antimicrobials for pneumonia in accordance to treatment guidelines was 13.28%. DISCUSSION AND CONCLUSION: There is irrational use of antibiotics. There is need for u n c o r r e c t e d p r o o f maintaining standard treatment guidelines in the hospital because it prevents irrational use of antibiotics.
Pattern of Antibiotic Use among Hospitalized Patients at a Level One Multidisciplinary Care Hospital
Healthcare
Background: Antimicrobial resistance is one of the world’s most serious health issues. Antibiotic resistance, excessive drug expense, and an increased risk of adverse reactions are all common outcomes of incorrect antibiotic prescribing. The goal of this study was to evaluate the prevalence of antibiotic prescriptions for inpatients to find areas for improvement. Methods: A retrospective study at Emergency Clinical County Hospital of Oradea, Romania was performed for five years between 2017 and 2021. Data was collected using medical records of the patients and reports from the pharmacy. Antibiotic consumption was expressed as DDD/100 BD according to the World Health Organization (WHO) by antibiotics, classes, and AWaRe classification. Results: The prevalence of antibiotic prescription was 53.8% during five years evaluated with a significant increase in 2021. A total of 13,677.42 DDD/100 BD antibiotics were prescribed, especially for surgical and medical prophylaxes. The most prescri...