Improved antibiotic usage following introduction of a novel prescription system
W. A. Durbin Jr, B. Lapidas and D. A. Goldmann
We investigated the impact of a novel antibiotic prescription system on
antibiotic use. After a two-month baseline monitoring period, an antibiotic
prescription form was introduced on surgical and medical wards, which
obliged physicians to categorize antibiotic use as prophylactic, empirical
(culture results unavailable), or therapeutic. Depending on the category,
administration of antibiotics was automatically discontinued after two days
(prophylactic), three days (empirical), or seven days (therapeutic) unless
the physician renewed the order or specified an alternate duration of
administration. In the subsequent two-month intervention period, 233 (60%)
of 390 surgical patients received prophylactic antibiotics compared with
281 (68%) of 413 in the baseline period. Mean duration of prophylaxis was
reduced from 4.9 +/- 2.4 days to 2.9 +/- 1.6 days. In the intervention
period, 11% of patients received their first prophylactic dose
postoperatively, compared with a 30% baseline rate. The percentage of
urology patients receiving appropriate therapy for urinary tract infection
increased from 38% to 89%. No significant changes in antibiotic use were
noted on the medical service. This antibiotic prescription system may have
a substantial impact on antibiotic use.
