[Evaluation of an advisory program in antibiotic therapy].
BACKGROUND
Increases in microbial resistance and pharmaceutical costs have prompted an interest in antibiotic control programs (ACP). Nevertheless, there is controversy on the optimal ACP design and implementation. An ACP based on the infectious diseases' specialist recommendations was evaluated.


METHODS
Interventional study of two hospital departments (medical and surgical). Antibiotic costs, mortality rate, readmissions following an infectious disease, and incidence of MRSA and Clostridium difficile between the intervention period and the same period in the previous year were compared. An anonymous survey among health care workers in both departments was conducted.


RESULTS
One-hundred and one antimicrobial therapy courses administered to 80 patients were evaluated. A total of 77 recommendations were issued, which consisted of therapy discontinuation (39%), switch to oral antibiotics (31%), decrease in the antimicrobial spectrum (24%) or enhancing the antimicrobial spectrum (6%). Eighty-five percent of the recommendations were accepted. The antimicrobial use remained stabilized, but the oral administration increased from 12.5 to 18.6 DDD/100 patient-days and parenteral use decreased from 25.9 to 22.3 DDD/100 patient-days. Antimicrobial costs decreased by 19.4% (901,794 pesetas). No changes, either in the mortality rate or in readmission rate due to infectious diseases was observed. In contrast, a decrease in the incidence of both MRSA (3.7% to 0.8%; p < 0.05) and Clostridium difficile (1.2% to 0%; p = 0.05) was observed. All health care workers that responded to the survey thought that ACP should be extended to the rest of the hospital.


CONCLUSIONS
Our ACP, based on the advice of an infectious diseases specialist, was very well accepted and allows for a decrease in antibiotic costs by simplified therapy. The ACP did not cause a negative impact on patients' outcomes and would probably help reducing the incidence of some nosocomial pathogens.
Cobo Reinoso
J
J
Servicios de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain. jcobo@hrc.insalud.es
Oliva Domínguez
J
J
Soler Vigil
M
M
Martínez-Beltrán
J
J
Pedraza Cezón
L
L
Moreno Guillén
S
S
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003376:Counseling; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D015397:Program Evaluation
D000900:Anti-Bacterial Agents