title: ['Third day intervention': an analysis of the factors associated with following the recommendations on the prescribing of antibiotics].
abstract: BACKGROUND
  Stewardship programs on the use of antibiotics usually include interventions based on non-compulsory recommendations for the prescribers. Factors related to the adherence to expert recommendations, and the implementation of these programmes in daily practice, are of interest.
  
  
  METHODS
  A randomized, controlled, multicentre intervention study was performed in 32 hospitalization units. Antibiotic prescriptions were evaluated by an infectious disease specialist on the third day. We describe the implementation of the intervention, the factors associated with adherence to recommendations, and the impact of the intervention.
  
  
  RESULTS
  A total of 3,192 interventions were carried out. Information sources used to prepare the recommendations varied significantly between centres. A modification was recommended in 65% of cases: withdrawal (47%), change in administration route (26%), change of drugs or number of antibiotics (27%), and change in dose (5%). Simplification of treatment accounted for 75% of all recommendations. Adherence was 68%, with significant differences between hospitals, and higher when the recommendations consisted of a dose adjustment or change of route, during the first intervention period, and also when recommendations were personally commented on, in addition to writing a note in the clinical chart. We did not find any reduction in antibiotic consumption or variation in the incidence of resistant pathogens.
  
  
  CONCLUSIONS
  An important proportion of antibiotic prescriptions may be susceptible to improvement, most of them towards simplification. The adherence to the intervention was high, but significant variations at different centres were observed, depending on the type of recommendation, and the study period. Those recommendations that were personally commented on were more followed more than those only written.
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España. Electronic address: lgsanmiguel@salud.madrid.org.
authors.forename: Lucía
authors.initials: L
authors.lastname: García-San Miguel
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Cobo
authors.affiliation: Servicio de Medicina Interna, Hospital Clínic, Barcelona, España.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Martínez
authors.affiliation: Servicio de Farmacología Clínica, Hospital Vall d'Hebron, Barcelona, España.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Arnau
authors.affiliation: Servicio de Medicina Interna, Hospital Son Espases, Palma de Mallorca, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Murillas
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Peña
authors.affiliation: Servicio de Medicina Interna, Hospital Parc Taulí, Sabadell, Barcelona, España.
authors.forename: Ferran
authors.initials: F
authors.lastname: Segura
authors.affiliation: Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Gurguí
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Virgen Macarena, Sevilla, España.
authors.forename: Juan
authors.initials: J
authors.lastname: Gálvez
authors.affiliation: Servicio de Microbiología, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Giménez
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, España.
authors.forename: Francesc
authors.initials: F
authors.lastname: Gudiol
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D002648:Child; D011307:Drug Prescriptions / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic policy; Antibiotic use control; Control de antibióticos; PROA; Política de antibióticos; Rational use of antibiotics; Stewardship program; Uso prudente de antimicrobianos