JAC Advance Access originally published online on May 5, 2004
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Journal of Antimicrobial Chemotherapy (2004) 53, 1062-1067
© 2004 The British Society for Antimicrobial Chemotherapy
Improving appropriateness of antibiotic therapy: randomized trial of an intervention to foster reassessment of prescription after 3 days
1 Division of Hospital Hygiene, University Hospital, Lausanne; 2 Clinical Epidemiology Center, Institute of Social and Preventive Medicine, University Hospital, Lausanne; 3 Service of Infectious Diseases, Department of Medicine, University Hospital, Lausanne, Switzerland
Received 6 November 2003; returned 8 January 2004; revised 19 February 2004; accepted 15 March 2004
Objectives: Reassessment of ongoing antibiotic therapy is an important step towards appropriate use of antibiotics. This study was conducted to evaluate the impact of a short questionnaire designed to encourage reassessment of intravenous antibiotic therapy after 3 days.
Patients and methods: Patients hospitalized on the surgical and medical wards of a university hospital and treated with an intravenous antibiotic for 3–4 days were randomly allocated to either an intervention or control group. The intervention consisted of mailing to the physician in charge of the patient a three-item questionnaire referring to possible adaptation of the antibiotic therapy. The primary outcome was the time elapsed from randomization until a first modification of the initial intravenous antibiotic therapy. It was compared within both groups using Cox proportional-hazard modelling.
Results: One hundred and twenty-six eligible patients were randomized in the intervention group and 125 in the control group. Time to modification of intravenous antibiotic therapy was 14% shorter in the intervention group (adjusted hazard ratio for modification 1.28, 95% CI 0.99–1.67, P = 0.06). It was significantly shorter in the intervention group compared with a similar group of 151 patients observed during a 2 month period preceding the study (adjusted hazard ratio 1.17, 95% CI 1.03–1.32, P = 0.02).
Conclusion: The results suggest that a short questionnaire, easily adaptable to automatization, has the potential to foster reassessment of antibiotic therapy.
Keywords: anti-infective agents, decision support systems, quality of healthcare, comparative study
* Correspondence address. Division of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland. Fax: +41-21-314-02-62; E-mail: Laurence.Senn{at}chuv.hospvd.ch
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