Impact of a web-based antimicrobial approval system on broad-spectrum cephalosporin use at a teaching hospital.
OBJECTIVE
To achieve sustained improvement in use of cefotaxime and ceftriaxone (CEFX) in a major teaching hospital, as measured against national antibiotic guidelines.


METHODS
Pre- and post-intervention survey of CEFX use in the Royal Melbourne Hospital, a tertiary hospital in Melbourne, Victoria.


METHODS
Web-based antimicrobial approval system linked to national antibiotic guidelines was developed by a multidisciplinary team and implemented in March 2001.


METHODS
Change in rate of CEFX use (defined daily doses [DDDs] per 1000 acute occupied bed days) over 8 months pre- and 15 months post-intervention; concordance of indication for CEFX with national antibiotic guidelines pre- and post-intervention.


RESULTS
CEFX use decreased from a mean of 38.3 DDDs/1000 bed days pre-intervention to 15.9, 18.7 and 21.2 DDDs/1000 bed days at 1, 4 and 15 months post-intervention. Concordance with national antibiotic guidelines rose from 25% of courses pre-intervention to 51% within 5 months post-intervention (P < 0.002). Gentamicin use also increased, from a mean of 30.0 to 48.3 DDDs/1000 bed days (P = 0.0001).


CONCLUSIONS
The web-based antimicrobial approval system achieved a sustained reduction in CEFX use over 15 months as well as increased prescribing concordance with antibiotic guidelines. It has potential for linking to electronic prescribing and for wider use for other drugs, as well as for research into the epidemiology of antibiotic use.
Richards
Michael J
MJ
Victorian Infectious Diseases Service, c/- Post Office, Royal Melbourne Hospital, Victoria 3050, Australia. Michael.Richards@mh.org.au
Robertson
Marion B
MB
Dartnell
Jonathan G A
JG
Duarte
Margarida M
MM
Jones
Nicholas R
NR
Kerr
Dale A
DA
Lim
Lyn-Li
LL
Ritchie
Peter D
PD
Stanton
Graham J
GJ
Taylor
Simone E
SE
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000191:economics; D002439:Cefotaxime / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use*; D004360:Drug Therapy, Computer-Assisted / Q000379:methods*; D017723:Drug Utilization Review / Q000379:methods* / Q000592:standards; D005572:Formularies, Hospital as Topic; D019983:Guideline Adherence; D006784:Hospitals, Teaching / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012985:Software Design
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D002439:Cefotaxime