Reassessment of intravenous antibiotic therapy using a reminder or direct counselling.
OBJECTIVE
Encouraging reassessment of intravenous antibiotic therapy at days 3-4 is an important step in the management of patients and may be done by delivering a questionnaire or through systematic infectious disease physician (IDP) advice to prescribers.


METHODS
In this before-and-after study, prescriptions of 13 selected intravenous antibiotics from surgical or medical wards were screened from a computer-generated listing and prospectively included. Three strategies were compared over three consecutive 8 week periods: conventional management by the attending physician (control group); distribution of a questionnaire to the physician (questionnaire group); or distribution of the questionnaire followed by IDP advice (Q-IDP group). The primary outcome was the percentage of modifications of antibiotic therapy at day 4, including withdrawal of therapy, de-escalation, oral switch or reducing the planned duration of therapy.


RESULTS
Overall, 402 prescriptions were included. At day 4, 48.9% and 54.5% of prescriptions were modified in the control and questionnaire groups, respectively (P = 0.35). In contrast, more prescriptions (66.2%) were modified in the Q-IDP group as compared with the control group (P = 0.004). Stopping therapy in the absence of apparent bacterial infection occurred significantly more often in the Q-IDP group than in the control (P < 0.0001) or questionnaire groups (P = 0.002).


CONCLUSIONS
This study shows a modest impact of only distributing a questionnaire aimed at reminding physicians to reassess therapy, whereas systematic IDP intervention improves the modification rate.
Unité de Contrôle, Epidémiologie et Prévention de l'Infection, Université Paris 12, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil, France. philippe.lesprit@hmn.aphp.fr
Philippe
P
Lesprit
Caroline
C
Landelle
Emmanuelle
E
Girou
Christian
C
Brun-Buisson
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D003376:Counseling; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents