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Reminding doctors which antibiotics to prescribe cuts C. difficile infection rates

A study published today in the Journal of Antimicrobial Chemotherapy1 provides the best available evidence that cases of Clostridium difficile infection (CDI)---one of the most common and increasing types of hospital-acquired infection---can be reduced in hospital wards if doctors prescribe narrow-spectrum antibiotics rather than broad-spectrum agents.

Researchers at the Royal Free Hospital in London, which now has the lowest CDI rates of any teaching hospital in the UK, investigated the best way to encourage doctors to make the switch from broad spectrum to narrow spectrum agents. They found that use of a pocket-sized laminated card telling doctors which antibiotics to prescribe combined with feedback on antibiotics use and CDI rates led to a significant drop in prescriptions of broad-spectrum agents, and an accompanying fall in CD infections.

The research team, from the Academic Department of Geriatrics, in the Medical School, suggest that both the study and the intervention could be successfully replicated in other hospitals in an attempt to reverse the rapid increase in CDI in the NHS.

This finding is especially important because CDI rates are rising rapidly in the UK and a new more virulent strain has recently been identified2 A 2005 study by the Healthcare Commission3 found that 38% of NHS Trusts did not restrict broad-spectrum antibiotic use, despite the known association between these compounds and CDI.

BACKGROUND

Drugs such as cephalosporins---so-called broad-spectrum agents because of their action against many types of bacteria---damage normal intestinal flora in addition to killing disease-causing microbes. This damage gives CD the opportunity to spread in the guts of patients recently treated with antibiotics. Infected patients can develop diarrhoea, colitis, and other conditions associated with intestinal inflammation. Rarely, CD infection can be fatal.

By contrast, drugs that target only
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Source:Oxford University Press


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