No single strategy effective to control antibiotic prescribing in hospitals

October 18, 2005

Plenty of promising strategies exist to control antibiotic-prescribing practices, but no single method emerges as the best for hospital patients, according to a new review of studies.

Antibiotics combat bacterial infections, like strep throat. But its overuse has been tied to a rise in organisms that build a resistance to the drugs.

The systematic review of data from 66 studies appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Most of the studies were conducted at a single hospital -- one of the main factors that prevented the researchers from drawing meaningful conclusions about the benefits of individual interventions. Also, none of the studies compared one intervention to another, so it was impossible to identify a superior approach.

"What might work in one hospital, won't necessarily work in another," said Erwin Brown, M.D., a medical microbiologist on the review team. "The literature wasn't sufficiently robust for us to say: 'This works or this doesn't.'"

Ralph Gonzales, M.D., an associate professor of medicine at the University of California, San Francisco, said antibiotic resistance is an especially critical problem in hospitals.

Each antibiotic is effective only against certain bacteria -- the organisms that cause infection. Often it takes a physician's best guess, laboratory tests and time to pinpoint the bacteria responsible for an illness.

"The chances are extremely low that an ambulatory-care patient will die because they don't get the correct antibiotic. That chance is greater for a critical-care patient in a hospital," Gonzales said.

Gonzales, who was not involved in the Cochrane review, has worked in the United States to craft guidelines for antibiotics prescribing. "It's important to pick the most tailored, narrow-spectrum antibiotic," he said.

There are many campaigns -- and generally agreed-on approaches -- to change antibiotic prescribing practices in community health centers and doctor's offices. But Gonzales said similar coordinated campaigns or agreements have lagged for hospitals.

Drug-resistance problems differ from hospital to hospital, Gonzales said. Each hospital has its own culture, he said, so the best resistance-reduction strategy may be linked to each facility's prescribing problems and goals.

In the Cochrane review, most of the interventions studied fell into one of two strategy groups: "persuasive" or "restrictive." Persuasive interventions included education meetings and verbal reminders. Restrictive interventions included automatic stop orders for certain antibiotics or required preauthorization from an infectious-disease specialist for some drugs.

The reviewers looked at how the interventions affected three different kinds of outcomes. Drug outcomes included whether or not a doctor prescribed an antibiotic, drug choice and dosage. Clinical outcomes measured the length of patient hospital stays, readmission and mortality rates. The reviewers also analyzed microbiological outcomes to determine whether an intervention affected the incidence of drug-resistant organisms commonly contracted in hospitals.

Seventy-seven percent (51) of the 66 studies showed a significant improvement in at least one outcome. "The results show that interventions to improve antibiotic prescribing to hospital inpatients are successful, and can reduce antimicrobial resistance or hospital acquired infections," the reviewers say.

While the Cochrane review looked at drug, clinical and microbiological outcomes across the 66 studies, only one study provided information on all three outcomes.
-end-
By Taunya English, Science Writer
Health Behavior News Service

FOR MORE INFORMATION
Health Behavior News Service: (202) 387-2829 or www.hbns.org.
Interviews: Contact Peter Davey at +44 1382 420000 or p.g.davey@chs.dundee.ac.uk
To receive a full copy of the review, contact Julia Lampam at +44 (0)1243 770668 or jlampam@wiley.co.uk

Davey P, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. The Cochrane Database of Systematic Reviews 2005, Issue 4.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Center for Advancing Health

Related Antibiotics Articles from Brightsurf:

Insights in the search for new antibiotics
A collaborative research team from the University of Oklahoma, the Memorial Sloan Kettering Cancer Center and Merck & Co. published an opinion article in the journal, Nature Chemical Biology, that addresses the gap in the discovery of new antibiotics.

New tricks for old antibiotics
The study published in the journal Immunity reveals that tetracyclines (broad spectre antibiotics), by partially inhibiting cell mitochondria activity, induce a compensatory response on the organism that decreases tissue damage caused during infection.

Benefits, risks seen with antibiotics-first for appendicitis
Antibiotics are a good choice for some patients with appendicitis but not all, according to study results published today in the New England Journal of Medicine.

How antibiotics interact
Understanding bottleneck effects in the translation of bacterial proteins can lead to a more effective combination of antibiotics / study in 'Nature Communications'

Are antivitamins the new antibiotics?
Antibiotics are among the most important discoveries of modern medicine and have saved millions of lives since the discovery of penicillin almost 100 years ago.

Hygiene reduces the need for antibiotics by up to 30%
A new paper published in the American Journal of Infection Control (AJIC), finds improved everyday hygiene practices, such as hand-washing, reduces the risk of common infections by up to 50%, reducing the need for antibiotics, by up to 30%.

Antibiotics: City dwellers and children take the most
City dwellers take more antibiotics than people in rural areas; children and the elderly use them more often than middle-aged people; the use of antibiotics decreases as education increases, but only in rich countries: These are three of the more striking trends identified by researchers of the NRW Forschungskolleg ''One Health and Urban Transformation'' at the University of Bonn.

Metals could be the link to new antibiotics
Compounds containing metals could hold the key to the next generation of antibiotics to combat the growing threat of global antibiotic resistance.

Antibiotics from the sea
The team led by Prof. Christian Jogler of Friedrich Schiller University, Jena, has succeeded in cultivating several dozen marine bacteria in the laboratory -- bacteria that had previously been paid little attention.

Antibiotics not necessary for most toothaches, according to new ADA guideline
The American Dental Association (ADA) announced today a new guideline indicating that in most cases, antibiotics are not recommended for toothaches.

Read More: Antibiotics News and Antibiotics Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.