title: Effect of a comprehensive, multidisciplinary, educational program on the use of antibiotics in a geriatric university hospital.
abstract: OBJECTIVE
  To assess the effect of a comprehensive, educational antibiotic management program designed to improve antibiotic use and reduce treatment costs in elderly patients with suspected urinary or respiratory tract infection.
  
  
  METHODS
  Interventional cohort study with 12 cross-sectional drug utilization reviews of antibiotic use before, during, and after the multifaceted intervention.
  
  
  METHODS
  A 304-bed university hospital for geriatric patients.
  
  
  METHODS
  A total of 3,383 elderly patients.
  
  
  METHODS
  An educational program including distribution of guidelines on the diagnosis and treatment of urinary and respiratory tract infections; lectures on geriatric infectious diseases; weekly ward rounds for patients with suspected infection; and targeted, individual counseling on diagnosis and antibiotic treatment of infections.
  
  
  METHODS
  Antibiotic utilization data were collected from the patients' records. Antimicrobial costs were calculated using 1998 hospital wholesale prices.
  
  
  RESULTS
  Of 3,383 screened patients, 680 (20%) received at least one antibiotic. During the study period, the mean number of prescribed drugs per patient increased from 5.9 to 7.6 (29%; P<.001). In contrast, a reduction of 15% was observed in the proportion of patients exposed to antibiotic agents (P=.08) and a drop of 26% in the number of antibiotics administered (P<.001). This resulted in a 54% decrease in cumulative daily antibiotic costs. In 83 (75%) of 110 surveyed patients, the guidelines were correctly implemented. The intervention had no measurable negative clinical effect.
  
  
  CONCLUSIONS
  A comprehensive, multifaceted educational program for treating urinary and respiratory tract infections in the elderly was a safe and practical method to change physicians' antibiotic prescribing practice and significantly reduce the consumption and costs of antibiotics in a geriatric hospital.
authors.affiliation: Department of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Monika
authors.initials: M
authors.lastname: Lutters
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Janssens
authors.forename: Hans
authors.initials: H
authors.lastname: Freudiger
authors.forename: François
authors.initials: F
authors.lastname: Herrmann
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Michel
authors.forename: Nicole
authors.initials: N
authors.lastname: Vogt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D017723:Drug Utilization Review; D004502:Education, Medical, Continuing; D005260:Female; D006782:Hospitals, Special; D006785:Hospitals, University; D006801:Humans; D016014:Linear Models; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D018709:Statistics, Nonparametric; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents