An effective strategy to reduce the overprescription of antibiotics by clinicians in the hospital’s outpatient and emergency departments
Keywords:
Strategy, Antibiotic, Antibiotic prescription, Rational drug use, Antibiotic smart useAbstract
Context: The antibiotic smart use (ASU) project of Burapha University Hospital did not achieve
its goals, although there was an ongoing campaign.
Objective: To understand what is an effective strategy to reduce the overprescription of
antibiotics by clinicians in outpatient and emergency departments across three specific diseases:
upper respiratory tract infections (URI), acute gastroenteritides (AGE) and fresh traumatic wound
infections.
Materials and Methods: The evaluated strategy included an ASU workshop for the clinicians,
the display of ASU brochures (for patients) at the desks of clinicians as well as the use of
computer programs that signalled an alarm when antibiotics were prescribed suspiciously. The
data was collected over 3 months, as well as before and after these safeguards were initiated.
Results: Our strategy could decrease the prescription rate of antibiotics for URI, AGE and fresh
traumatic wound infections by 9.39% (p < 0.001, 95%CI 7.48-11.31), 7.03% (p < 0.001, 95%CI 3.72-
10.33) and 2.60% (p = 0.020, 95%CI 0.40-4.80), respectively. However, there was no difference
in the admission rate for patients with URI, or for the rate of hospital revisits within 48 hours. In
patients with AGE, we found the rate of hospital revisits within 48 hours by 0.61% (p = 0.025,
95%CI 0.08-1.13). Yet, there was no difference in admission rates for patients with AGE. What’s
more, there was no difference in the frequency of fresh traumatic wound infections.
Conclusions: The implementation of a strategy to reduce the overprescription of antibiotics
associated with the three diseases as mentioned above was inconclusive.
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