Hospital Antibiotic Policies Improve Prescription Practices

Researchers at the University of Dundee, University College London, and other institutions searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase for studies examining the effectiveness and safety of interventions designed to improve antibiotic prescribing to hospital inpatients, and to investigate the effect of different intervention functions. In all, the researchers found 221 studies from the United States, Europe, Asia, South America, and Australia.

The researchers found that interventions broadly fell into two categories; 'restrictive' techniques applied rules to make physicians prescribe properly, whilst 'enabling' techniques provided advice or feedback to help physicians make more informed prescribing decisions. In both cases, the aim of the intervention was to increase the number of appropriate prescribing decisions so that patients who were unlikely to benefit from antibiotics did not get them, whilst they were still used for patients who stood to benefit from them.

The results showed that interventions that included enabling or restrictive techniques were consistently more effective than interventions that relied on simple education alone. Moreover, a synergistic effect existed, with enabling techniques increasing the effectiveness of restrictive techniques. In addition, the interventions shortened duration of antibiotic use from 11 to 9 days per patient, and reduced hospital stay from an average of 13 days to 12 per patient. The review was published on February 9, 2017, in The Cochrane Library.

“We do not need more studies to answer the question of whether these interventions reduce unnecessary antibiotic use, but we do need more research to understand why the most effective behavior change techniques are not more widely adopted within hospital settings,” concluded lead author Peter Davey, PhD, of the UD department of population health sciences. “Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection, and reduce unnecessary prescriptions.”

For the study, the researchers defined restriction as using rules to reduce the opportunity to engage in the target behavior, or increase the target behavior by reducing the opportunity to engage in competing behaviors. Enablement was defined as increasing the means and reducing the barriers in order to increase capability or opportunity.