PT  - JOURNAL ARTICLE
AU  - Matthew S. Lloyd
AU  - Colin Murray
AU  - Arlene Shaw
AU  - Tom C. Fardon
AU  - Robin P. Smith
AU  - Stuart Schembri
AU  - James D. Chalmers
TI  - Reducing inappropriate antibiotic use in lower respiratory tract infection (LRTI); a quality improvement study
DP  - 2013 Sep 01
TA  - European Respiratory Journal
PG  - 5046
VI  - 42
IP  - Suppl 57
4099  - http://erj.ersjournals.com/content/42/Suppl_57/5046.short
4100  - http://erj.ersjournals.com/content/42/Suppl_57/5046.full
SO  - Eur Respir J2013 Sep 01; 42
AB  - IntroductionProlonged courses of antibiotics result in adverse events for patients and lead to antibiotic resistance. We designed an intervention study to assess the benefits and safety of a new prescribing protocol for antibiotic duration for patients with LRTIs on a respiratory ward in a Scottish teaching hospital.MethodsWe included all patients who received antibiotics for a LRTI identified over 1 year. In the initial phase we recorded mode and duration of antibiotic use. Outcome measures were: antibiotic related adverse effects, HDU/ITU admission, length of stay and death. The second phase followed implementation of an antibiotic protocol consisting of automatic stop dates, severity guided duration of antibiotics (duration 5 days for low risk CURB65 patients, 7 days for high severity patients) and pharmacist feedback. Antibiotic use was categorised into four therapeutic sub-groups; pneumonia (PN), acute exacerbations of COPD (AECOPD), exacerbations of asthma (ExA) and 'other' (O).ResultsThere were 281 pre and 221 post-intervention patients included. A significant decrease in antibiotic duration (days) was seen across all patients (8.3→6.8 p<0.001) and across each individual diagnostic sub-group (p<0.001); PN (9.3→7.1), AECOPD (7.7→6.2), ExA (6.3→5.0) and O (8.5→6.6). This was associated with a significant decrease in adverse events attributable to antibiotic use when comparing pre to post-intervention groups, from 31.3%→19.0% (p<0.0001). There was no significant effect of the intervention on mortality rate (8.9%→8.1% p=0.6).ConclusionA multidisciplinary intervention can significantly reduce inappropriate antibiotic use and antibiotic associated adverse effects.