Simple Annotation Tactic Cuts Antibiotic Overuse

Simple low-tech notations to stop prescribing antibiotics after a set period can dramatically reduce the overuse of antibiotics and the accompanying adverse reactions, according to a new study.

Researchers at the University of Dundee (United Kingdom) and Ninewells Hospital (Dundee, United Kingdom) conducted a study involving 281 patients during a six month observational period prior to the initiation of the automatic antibiotics stop orders, and a subsequent six moth treatment period involving 221 postintervention patients. The intervention itself involved a hand written annotation (“X”) on the calendar date when antibiotic use should end, and a line through the days for the remainder of the month to prevent the stop order from being overlooked.

The researchers found that overall, adverse events associated with antibiotic use decreased by almost 40%, from 31.3% to 19%. Pneumonia patients' antibiotic use dropped from 9.3 days to 7.1 days; chronic obstructive pulmonary disease (COPD) 7.7 days to 6.2 days; asthma patients antibiotic use dropped from 6.3 to 5 days; for other pulmonary diseases, patients' antibiotic use dropped from 8.5 days to 6.6 days. In addition, there was a nonsignificant decrease in mortality from 8.9% to 8.1%. The study was presented at the European Society of Cardiology (ESC) annual congress, held during September 2013 in Amsterdam (The Netherlands).

“During both phases of this study, researchers monitored antibiotic side-effects, including new symptoms occurring during the period of antibiotic exposure that were potentially caused by the antibiotics,” said lead author and stud presenter Matthew Lloyd, MD. “We found that through prescribing automatic stop dates and working with our multidisciplinary colleagues, we can help prevent this problem and reduce patient harm.”

“We didn't find any real resistance to the program as such,” added study coauthor Arlene Shaw, NPharm, a specialist pharmacist who worked on the Ninewells Hospital wards. “But it just took time to implement that change in culture. It took a little education, but there was never any resistance because there is a clear indication for it.”

The overuse of antibiotics and antibiotic resistance are one of the biggest threats to human health emerging worldwide. Additionally, antibiotic use is not without peril to the patient; aside from gastrointestinal (GI) problems such as diarrhea, the use of antibiotics can interfere with other treatments through drug-drug interactions, treatment of hospital-acquired infections (HAIs) such as Clostridium difficile, and in treatment of intravenous (IV) line infections, as well as in other areas.

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Ninewells Hospital
University of Dundee