Implementation of treatment guidelines to support judicious use of antibiotic therapy
Article first published online: 15 APR 2009
© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd
Journal of Clinical Pharmacy and Therapeutics
Volume 35, Issue 1, pages 71–78, February 2010
How to Cite
Deuster, S., Roten, I. and Muehlebach, S. (2010), Implementation of treatment guidelines to support judicious use of antibiotic therapy. Journal of Clinical Pharmacy and Therapeutics, 35: 71–78. doi: 10.1111/j.1365-2710.2009.01045.x
- Issue published online: 6 JAN 2010
- Article first published online: 15 APR 2009
- Received 11 July 2008, Accepted 31 January 2009
- antibiotic therapy;
- guideline adherence;
- intervention program;
- physician training;
- prescribing practices;
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.