title: [Effect of a computer application on appropriate use and control of broad spectrum antibiotics].
abstract: BACKGROUND
  Antibiotics are among the greatest contributions of modern medicine. However, since the onset of the antibiotic age, resistance has emerged, threatening the future usability of these drugs. The complexity of antibiotic prescribing and associated expense has led to the development of infectious disease (ID) expert stewardship programs.
  
  
  OBJECTIVE
  To describe an in-house created computer application, in use since 2005 with which all restricted antimicrobials are ordered and approved by ID physicians before being supplied by the pharmacy.
  
  
  RESULTS
  In the nine years since the application was adopted by the entire hospital, 173,436 prescriptions for restricted antibiotics have been ordered through the application, of which 52% were for male patients, 8% for children ≤ 20 years, 31% for adults 21-70 years old and 61% for patients > 70. All prescriptions were reviewed by ID physicians; their response included approval (mean 87%, range 82-92%), rejection (7%, 3-12%), or change (6%, 4-18%). The latter two decisions always involved written and/or oral interaction with the prescribing physicians. The result analysis showed that: by clinical diagnoses, the approval rate ranged from 82% (for central line associated infection) to 94% (for tuberculosis); by class of antimicrobial, the approval rate ranged from 71% (IV ciprofloxacin) to 95% (IV amoxicillin-calvulanate). Overall hospital expenditure on antimicrobials, corrected by 100 admissions and 100 admission days, did not change significantly.
  
  
  CONCLUSIONS
  During the nine years of its use, the described computer program has significantly contributed to physician awareness of appropriate antibiotic use, provided tools to assist physicians in their choice of antimicrobial treatment, allowed ID supervision with unprecedented scope and depth and has significantly contributed to cost control.
authors.forename: David
authors.initials: D
authors.lastname: Raveh-Brawer
authors.forename: Yonit
authors.initials: Y
authors.lastname: Wiener-Well
authors.forename: Tamar
authors.initials: T
authors.lastname: Lachish
authors.forename: Eli
authors.initials: E
authors.lastname: Ben-Chetrit
authors.forename: Orly
authors.initials: O
authors.lastname: Megged
authors.forename: Maskit
authors.initials: M
authors.lastname: Bar-Meir
authors.forename: Maymone
authors.initials: M
authors.lastname: Dahan
authors.forename: Tzipora
authors.initials: T
authors.lastname: Shraber
authors.forename: Estelle
authors.initials: E
authors.lastname: Bukatman
authors.forename: Amos M
authors.initials: AM
authors.lastname: Yinnon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D002648:Child; D016527:Drug Costs; D024881:Drug Resistance, Bacterial; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012984:Software; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents