Interventions for Improving Antibiotic Prescribing in Hospitals Reviewed

A Cochrane review concluded that interventions used to help physicians prescribe antibiotics properly were effective at raising compliance with antibiotic policy and decreasing the duration of treatment. 

Multidrug-resistant bacterial infections can lead to prolonged hospital stay and mortality compared with infections caused by susceptible bacteria. Study authors updated a systematic review to evaluate the effect of interventions to improve antibiotic prescribing in hospital inpatients. 

The effects of two intervention functions—restriction and enablement—and the safety and efficacy of interventions to improve antibiotic prescribing were evaluated. “Restriction” was defined as using rules to reduce the opportunity to engage in the target behavior and “enablement” was defined as increasing means/reducing barriers to increase capability or opportunity. 

A total of 221 studies were included for this update. Most hospitalized patients were treated according to antibiotic prescribing policy with the intervention vs. no intervention according to 29 randomized controlled trials of predominantly enablement interventions, reflecting an increase from 43% to 58%. 

The length of antibiotic treatment reduced by 1.95 days (95% CI: 2.22 to 1.67) from 11.0 days. Interventions were associated with improvement in prescribing according to antibiotic policy in routine clinical practice. Mortality risk was similar between both intervention and control groups, indicating that antibiotic use can likely be decreased without negatively affecting mortality (RD 0%, 95% CI: –1 to 0%). Antibiotic stewardship interventions probably decrease length of stay by 1.12 days (95% CI: 0.7 to 1.54 days). 

Concerns that restrictive interventions may delay treatment and create a negative professional culture “because of breakdown in communication and trust between infection specialists and clinical teams” were raised in some of the studies.

Study authors were able to conclude that restriction and enablement were separately tied to higher compliance with antibiotic policies, and that enablement “enhanced the effect of restrictive interventions.” Moreover, the enabling interventions that incorporated feedback were likely to be more effective than those without feedback although it was found in only a small number of interventions. In general, interventions safely reduced unnecessary antibiotic use in hospitals even though the majority did not utilize the most effective behavior change techniques. 

Additional studies should “focus on targeting treatment and assessing other measures of patient safety, assess different stewardship interventions, and explore the barriers and facilitators to implementation.” 

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