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The Short- and Long-term Effects of a Handbook on Antimicrobial Prescribing Patterns of Hospital Physicians

Published online by Cambridge University Press:  02 January 2015

James Earl D'Eramo ,
Herbert L. DuPont ,
Gary A. Preston ,
Michael H. Smolensky  and
Lewis H. Roht
James Earl D'Eramo*
Affiliation:
University of Texas Health Science Center at Houston, The School of Public Health and The Medical School, Houston, Texas
Herbert L. DuPont
Affiliation:
University of Texas Health Science Center at Houston, The School of Public Health and The Medical School, Houston, Texas
Gary A. Preston
Affiliation:
University of Texas Health Science Center at Houston, The School of Public Health and The Medical School, Houston, Texas
Michael H. Smolensky
Affiliation:
University of Texas Health Science Center at Houston, The School of Public Health and The Medical School, Houston, Texas
Lewis H. Roht
Affiliation:
University of Texas Health Science Center at Houston, The School of Public Health and The Medical School, Houston, Texas
*
70 Greenwich Avenue, #500. New York, NY 10011
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Abstract

This study evaluates the effect of a specially designed, physician-oriented handbook of antimicrobial use on the prescribing patterns of a group of 50 doctors at a university hospital. Data were evaluated over a period of one-and-one-half years, before and after the distribution of the handbook. For the purposes of this study, antimicrobial therapy was classified: 1) inappropriate if it violated one of a number of recognized principles of antimicrobial therapy, 2) appropriate if it agreed with specific recommendations or alternatives given in the distributed reference handbook, and 3) acceptable if it was neither inappropriate nor appropriate as defined by the handbook. An initial survey of antimicrobial prescribing patterns was made. Five months later the handbook was distributed. A two-week orientation program, consisting of the distribution and promotion of the problem-oriented, pocket-sized handbook of appropriate antimicrobial therapy, was conducted. The handbook, which was developed by the authors and reviewed and approved by a panel of infectious disease specialists, presented guidelines for appropriate and efficacious usage of antimicrobial agents as most currently accepted in common clinical infections. Subsequent surveys were then conducted two weeks, three months, and six months after distribution of the handbook. A statistically significant difference (p <0.01) in antimicrobial prescribing patterns was noted between the survey conducted two weeks after the introduction of the handbook and the other surveys. In this survey, while therapy classified inappropriate decreased from 45% to 28%, therapy considered appropriate as recommended increased from 33% to 53%. The findings of this study demonstrated that the introduction and promotion of the handbook decreased abuse and increased proper use of antimicrobial therapy, although the effect is sustainable for only a short duration—no longer than three months. These results indicate the need for a vigorous, updated program to achieve and maintain current appropriate antibiotic therapy in clinical medicine.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 4 , Issue 4 , August 1983 , pp. 209 - 214
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1983

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References

1.Audits of antimicrobial usage. Veterans Administration Ad Hoc Interdisciplinary Advisory Committee on Antimicrobial Drug Usage. JAMA 1977; 237:1001–1969.Google Scholar
2.Jackson, GG: Perspective from a quarter century of antibiotic usage. JAMA 1974; 227:634–637.CrossRefGoogle ScholarPubMed
3.Simmons, HE, Stolley, PD: This is medical progress? Trends and consequences of antibiotic use in the United States. JAMA 1974; 227:1023–1028.Google Scholar
4.Kunin, CM: Antibiotic accountability. N Engl J Med 1979; 301:380–381.Google Scholar
5.Shapiro, M, Townsend, TR, Rosner, B, et al: Use of antimicrobial drugs in general hospitals. Patterns of prophylaxis. N Engl J Med 1979; 301:351–355.Google Scholar
6.Jones, SR, Barks, J, Bratton, T, et al: The effect of an educational program upon hospital antibiotic use. Am J Med Sci 1977; 273:79–85.Google Scholar
7.Achong, MR, Theal, HK, Wood, J, et al: Changes in hospital antibiotic therapy after a quality-of-use study. Lancet 1977; 2:1118–1122.CrossRefGoogle ScholarPubMed
8.McGowan, JE Jr, Finland, M: Effects of monitoring the usage of antibiotics: An inter hospital comparison. South Med J 1976; 69:193–195.CrossRefGoogle Scholar
9.Castle, M, Wilfert, CM, Cate, TR, et al: Antibiotic use at Duke University Medical Center. JAMA 1977; 237:2819–2822.Google Scholar
10.Kunin, CM, Tupasi, T, Craig, WA: Use of antibiotics: A brief exposition of the problem and some tentative solutions. Ann Intern Med 1973; 79:555–556.Google Scholar
11.McGowen, JE Jr, Finland, M: Usage of antibiotics in a general hospital: Effect of requiring justification. J Infect Dis 1974; 130:165–168.Google Scholar
12.Recco, RA, Gladstone, JL, Friedman, SA, et al: Antibiotic control ina municipal hospital. JAMA 1979; 241:2283–2286.Google Scholar