( -June 2001) and afterwards (July 2001-M...)Reminding doctors which antibiotics to prescribe cuts C. difficile infection rates

-June 2001) and afterwards (July 2001-March 2003). A statistically significant drop in use of both cephalosporin and amoxicillin/clavulanate was observed after the narrow-spectrum policy came into effect. Prescriptions for antibiotics not specified by the policy did not change during this time, suggesting that the feedback and laminated card had had the desired targeted effect. There was also a significant fall in rates of CDI associated with the policy change.

"We have shown that introduction of a narrow-spectrum antibiotic policy, reinforced by feedback, was associated with significant changes in targeted antibiotics and a significant reduction in CDI", explains Dr Stone.

"National figures for CD and associated diseases showed the Royal Free to have the lowest rates of any teaching hospital. This success is largely being attributed to the antibiotic policies described in the paper", he adds.

The authors think their study could be a useful reference for other centres where cephalosporin use is higher than in the Royal Free. Compared with many other hospitals, cephalosporin use was already low at the beginning of the study and the intervention was still highly successful, indicating that even better results could be achieved in institutions where a greater reduction is desirable.

Dr Stone and colleagues used an interrupted time series design, which includes a single group of study subjects assessed before an after an intervention (in this case a change to antibiotic prescribing policy). This design includes measurement of many different variables both before and after the intervention, including a set of "control outcomes" that are not expected to change during the course of the study, to reduce the potential contribution of confounding factors to any result.

This design means the study provides stronger evidence than previous investigations of similar interventions. "Nearly all previous studies assessing interven
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Source:Oxford University Press

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