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Reassessment of intravenous antibiotic therapy using a reminder or direct counselling

2010; Oxford University Press; Volume: 65; Issue: 4 Linguagem: Inglês

10.1093/jac/dkq018

1460-2091

P. Lesprit, Caroline Landelle, Emmanuelle Girou, C. Brun‐Buisson,

Bacterial Identification and Susceptibility Testing

Encouraging reassessment of intravenous antibiotic therapy at days 3-4 is an important step in the management of patients and may be done by delivering a questionnaire or through systematic infectious disease physician (IDP) advice to prescribers.In this before-and-after study, prescriptions of 13 selected intravenous antibiotics from surgical or medical wards were screened from a computer-generated listing and prospectively included. Three strategies were compared over three consecutive 8 week periods: conventional management by the attending physician (control group); distribution of a questionnaire to the physician (questionnaire group); or distribution of the questionnaire followed by IDP advice (Q-IDP group). The primary outcome was the percentage of modifications of antibiotic therapy at day 4, including withdrawal of therapy, de-escalation, oral switch or reducing the planned duration of therapy.Overall, 402 prescriptions were included. At day 4, 48.9% and 54.5% of prescriptions were modified in the control and questionnaire groups, respectively (P = 0.35). In contrast, more prescriptions (66.2%) were modified in the Q-IDP group as compared with the control group (P = 0.004). Stopping therapy in the absence of apparent bacterial infection occurred significantly more often in the Q-IDP group than in the control (P < 0.0001) or questionnaire groups (P = 0.002).This study shows a modest impact of only distributing a questionnaire aimed at reminding physicians to reassess therapy, whereas systematic IDP intervention improves the modification rate.