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

specific types of bug cause less damage to normal gut bacteria and therefore reduce the likelihood that CD will take hold.

In their audit study, Dr Sheldon Stone, of the Academic Department of Geriatrics, Royal Free and University College Medical School, London, and colleagues investigated whether use of feedback to individual doctors about their prescribing habits can improve adherence to a narrow-spectrum antibiotic prescribing policy, thereby reducing CD cases.

"National guidelines recommend narrow-spectrum antibiotic policies and suggest a variety of methods to ensure these are implemented, but feedback is not mentioned in national guidelines as a way of addressing prescribing behaviour," says Dr Stone.

The team, working at the Royal Free Hospital in London, studied prescribing and CDI rates in three wards for acute care of the elderly where CD was endemic. When the study began, doctors working on the wards had already been told to use less cephalosporin to treat bacterial infections, but this policy had resulted in increased use of another broad-spectrum antibiotic, amoxicillin/clavulanate.

To prevent future CDI rises as a result of the increased use of amoxicillin/clavulanate, a new narrow-spectrum policy was implemented as part of the hospital's clinical governance programme at the beginning of July 2001. This policy recommended less use of amoxicillin/clavulanate, increased use of benzyl penicillin, trimethoprim, and amoxicillin, and further restricting cephalosporin use.

Dr Stone and colleagues analysed the effectiveness of reinforcing this new policy with a pocket-sized laminated card telling doctors which drugs to use in which circumstances. These instructions were combined with feedback to doctors every 2-3 months on how many courses of each specific drug they had prescribed, and ward rates of CD infection and MRSA.

Doctors' prescriptions were compared before the policy change (September 1999
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Source:Oxford University Press


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