title: [Antibiotics in elderly patients: Impact of clinical practice evaluation].
abstract: OBJECTIVE
  Improving the use of antimicrobial drugs is a national objective. To this end an evaluation of clinical practice was implemented on prescribed antibiotics in elderly patients, in the Besançon Teaching Hospital.
  
  
  METHODS
  In 2005, a clinical audit compared the adequacy of antibiotic prescriptions to national guidelines in 37 patients. An improvement plan was implemented, including the drafting of local guidelines (adapted national guidelines) "Antibiotic prescription in elderly patients" by a multidisciplinary team. The Antibiotics Committee approved it. A retrospective study compared antibiotic prescription of 62 patients to these guidelines. The methodology was based on Gyssen's algorithm. The assessment criteria were: relevance of the indication, absence of a better alternative, respect of recommended dose, duration, and timing.
  
  
  RESULTS
  The rate of overall conformity was 26% in 2005, 57% in 2007. Antibiotic choice was adequate in 61% of cases in 2005, 78% in 2007. In 63% of cases, a more efficient alternative was advised in 2005, 10% of cases in 2007. Treatment duration, dose, and timing were adequate in 54 - 92 - 96% in 2005 respectively and 86 - 92 - 100% of cases in 2007. Ciprofloxacin was prescribed in first line for 42% of urinary infections in 2005, 0% in 2007.
  
  
  CONCLUSIONS
  This approach improved antibiotic prescriptions because of better guideline observance by physicians. The main improvement concerned fluoroquinolones. It should be continued to confirm antibiotic good use and protect our hospital bacterial ecology.
authors.affiliation: Pôle pharmaceutique, hôpital Jean-Minjoz, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon, France.
authors.forename: S
authors.initials: S
authors.lastname: Raymond
authors.forename: M
authors.initials: M
authors.lastname: Bourdelin
authors.forename: M
authors.initials: M
authors.lastname: Becker
authors.forename: T
authors.initials: T
authors.lastname: Henon
authors.forename: I
authors.initials: I
authors.lastname: Patry
authors.forename: J
authors.initials: J
authors.lastname: Leroy
authors.forename: S
authors.initials: S
authors.lastname: Limat
mesh_terms: D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology; D003953:Diagnosis-Related Groups; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing; D008297:Male; D008485:Medical Audit; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents