JAC Advance Access published online on May 5, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh236
© 2004 by The British Society for Antimicrobial Chemotherapy
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1 Division of Hospital Hygiene,
University Hospital, Lausanne;
* To whom correspondence should be addressed. E-mail: Laurence.Senn{at}chuv.hospvd.ch.
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.
Revised February 19, 2004
Accepted March 15, 2004
Original article
Improving appropriateness of antibiotic therapy:
randomized trial of an intervention to foster reassessment of prescription
after 3 days
2 Clinical
Epidemiology Center, Institute of Social and Preventive Medicine,
University Hospital, Lausanne;
3 Division of Hospital Hygiene,
University Hospital, Lausanne; ; Service
of Infectious Diseases, Department of Medicine, University Hospital,
Lausanne, Switzerland
Abstract 
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