Persistence of improvement in antibiotic prescribing in office practice

We evaluated persistence of the prescribing improvement seen in a previous statewide controlled trial, which measured improvement in the prescribing of contraindicated antibiotics and oral cephalosporins in the year after an educational intervention. Doctors visited by physician-counselors substantially improved their prescribing of both classes of drugs. The beneficial effect of the physician-counselors persisted throughout year 2, with attributable reductions in prescribing of 30% and savings of $950 for each doctor visited. The marked and lasting improvement in prescribing produced by the physician-counselors suggests using this model to develop ongoing programs to improve prescribing.     

Changing antibiotic sensitivity patterns in shigellosis.

Over five and a half months stool cultures were performed in 154 patients admitted with suspected bacillary dysentery to the Professorial Paediatric Unit of the Teaching Hospital, Galle. Thirty one patients had a positive stool culture; Shigella dysenteriae type 1 was isolated in 23 patients, and S flexneri in 8. In both groups the antibiotic sensitivity pattern was uniform, the only difference being S dysenteriae type 1 being resistant to nalidixic acid while S flexneri was sensitive. This antibiotic sensitivity pattern was different to that reported from Colombo during the same period. Complications were observed in some patients with S flexneri infection.     

Impact of an electronic antibiotic advice and approval system on antibiotic prescribing in an Australian teaching hospital

The impact of a computer-based infectious diseases electronic antibiotic advice and approval system ("IDEA(3)S") was assessed as an alternative to a labour-intensive, phone-based approval system. IDEA(3)S-based approvals replaced 48% of all approvals for the most frequently requested antimicrobial agents (ceftriaxone/cefotaxime, vancomycin) and were associated with stable overall rates of antimicrobial use. Antibiotic prescribing for community-acquired pneumonia was 76% concordant with IDEA(3)S recommendations, and clinical acceptance of IDEA(3)S was excellent. Successful implementation required a coordinated, evidence-based approach between clinicians, pharmacists and hospital administration, together with ongoing staff education and feedback of results. IDEA(3)S is a useful new adjunct to routine clinician consultation to support appropriate antibiotic prescribing for a number of common indications in hospitals.     

Reducing long-term diazepam prescribing in office practice. A controlled trial of educational visits

We conducted a controlled, statewide trial of the efficacy of an educational visit by a physician counselor in the reduction of diazepam prescribing in outpatient practice. A novel aspect of this trial was the provision of a schedule for gradual withdrawal of long-term diazepam users from drug therapy; 51% of visited doctors attempted to withdraw patients from diazepam therapy and 26% utilized the withdrawal schedule. The entire group of 43 visited doctors reduced the rate of long-term diazepam users in their practice by 18% relative to the control group; the subgroup of doctors who utilized the withdrawal schedule had and even greater reduction of 33%. These results suggest that practicing doctors are concerned with long-term use of diazepam and that the educational visit by another physician is one method for reducing such use.     

Effects of computer-aided clinical decision support systems in improving antibiotic prescribing by primary care providers: a systematic review

Objective To assess the effectiveness of computer-aided clinical decision support systems (CDSS) in improving antibiotic prescribing in primary care.Methods A literature search utilizing Medline (via PubMed) and Embase (via Embase) was conducted up to November 2013. Randomized controlled trials (RCTs) and cluster randomized trials (CRTs) that evaluated the effects of CDSS aiming at improving antibiotic prescribing practice in an ambulatory primary care setting were included for review. Two investigators independently extracted data about study design and quality, participant characteristics, interventions, and outcomes.Results Seven studies (4 CRTs, 3 RCTs) met our inclusion criteria. All studies were performed in the USA. Proportions of eligible patient visits that triggered CDSS use varied substantially between intervention arms of studies (range 2.8–62.8%). Five out of seven trials showed marginal to moderate statistically significant effects of CDSS in improving antibiotic prescribing behavior. CDSS that automatically provided decision support were more likely to improve prescribing practice in contrast to systems that had to be actively initiated by healthcare providers.Conclusions CDSS show promising effectiveness in improving antibiotic prescribing behavior in primary care. Magnitude of effects compared to no intervention, appeared to be similar to other moderately effective single interventions directed at primary care providers. Additional research is warranted to determine CDSS characteristics crucial to triggering high adoption by providers as a perquisite of clinically relevant improvement of antibiotic prescribing.     

初级医疗中的呼吸道感染疾病预后——准确信息有助于减少抗生素应用

就在亚历山大·弗莱明（Alexander Fleming）及其团队因发现青霉素的抗菌作用而获得诺贝尔奖的同年（1954）,弗莱明提出要警惕细菌耐药的风险。