title: Hospital antibiotic prescribing successfully modified by 'immediate concurrent feedback'.
abstract: 1. To determine the effectiveness of ongoing immediate concurrent feedback (ICF) in minimizing 'inappropriate' sultamicillin or co-amoxiclav prescribing via the parenteral route (i.e. when the oral route was accessible and not contraindicated), a prospective controlled audit was carried out on hospital inpatients over a 20 month period. 2. After an education programme to promote oral rather than unnecessary intravenous (i.v.) use of sultamicillin, co-amoxiclav and certain other drugs, an ongoing ICF strategy was instituted. 3. ICF entailed issue of memos on the following day to prescribers of i.v. sultamicillin or co-amoxiclav for inpatients in whom this route was deemed 'inappropriate', by a specially trained nurse using strict objective criteria. The memos recommended oral prescribing (particularly of co-amoxiclav, currently the less expensive alternative). 4. After starting ICF, there were consistent, clinically and statistically significant reductions in the monthly proportions of (i) admissions prescribed i.v. sultamicillin or co-amoxiclav (38% P < 0.001), (ii) those in whom the route was 'inappropriate' (75%, P < 0.001), and (iii) corresponding ratios of i.v./oral usage and expenditure, oral sultamicillin/co-amoxiclav usage and expenditure, as well as total and per admission expenditure on i.v. forms (> or = 43%, P < 0.01). 5. For i.v. cefuroxime (for which there was no ICF) and its oral counterpart cefuroxime-axetil, there were no comparable changes in usage or expenditure. 6. This simple, ongoing ICF strategy was effective and well accepted; estimated net monthly savings being HK$26-30,000.
authors.affiliation: Infection Control Unit, University of Hong Kong.
authors.forename: W H
authors.initials: WH
authors.lastname: Seto
authors.forename: T Y
authors.initials: TY
authors.lastname: Ching
authors.forename: M
authors.initials: M
authors.lastname: Kou
authors.forename: S C
authors.initials: SC
authors.lastname: Chiang
authors.forename: I J
authors.initials: IJ
authors.lastname: Lauder
authors.forename: C R
authors.initials: CR
authors.lastname: Kumana
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis / Q000191:economics*; D011307:Drug Prescriptions; D017721:Hospital Costs; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents