By Andrew M. Seaman
NEW YORK (Reuters Health) - Programs that attempt to encourage or force hospital doctors to cut back on prescribing antibiotics achieve that goal and help reduce the number of dangerous drug-resistant bacteria, says a review of past research.
According to the review's lead author, the fear is that doctors are prescribing too many antibiotics, which helps to breed hard-to-treat drug-resistant bacteria. It also leaves patients vulnerable to secondary, opportunistic infections like clostridium difficile - or "C. diff."
"Antibiotic resistance is recognized worldwide as a public health problem that's just getting worse. Really around the world people are worried that we'll end up with bacteria that are resistant to the antibiotics we've got," said Dr. Peter Davey, of the University of Dundee in Scotland.
The researchers reported their findings in the Cochrane Library, which is published by the Cochrane Collaboration, an international research organization that evaluates medical evidence.
For the new review, Davey and his colleagues searched medical research databases for high-quality studies that evaluated whether hospital programs to curb the number of antibiotics doctors prescribed worked, didn't harm patients and reduced the number of drug-resistant bacteria detected or the number of antibiotic-related infections.
In the 89 studies from 19 different countries the researchers found, three types of programs were evaluated.
One approach restricted doctors' ability to prescribe antibiotics by putting up roadblocks, such as needing approval from an expert or needing to fill out forms. Another set of programs tried to persuade doctors to cut back by educating and reminding them about safe antibiotic use. The third type of intervention focused on improved laboratory testing and computer-based decisionmaking tools for doctors.
Overall, programs that restricted a doctor's ability to prescribe antibiotics were 32 percent more effective in the first month than those that tried to persuade and educate.
Davey told Reuters Health that it's difficult to say how this difference translates into changes in the actual number of antibiotics prescribed, because each study measured that differently.
After six months, restrictive programs also did a better job at reducing drug-resistant bacteria and antibiotic-related infections, compared to the persuasive programs. "We got good evidence that restrictive interventions work faster in terms of changing prescribing and microbial outcomes," Davey said.
However, the benefits of the restrictive intervention seemed to disappear after one year, which suggests the persuasive and education programs caught up in terms of their effectiveness, Davey said.
He added that while restrictive programs may be the best choice for hospitals experiencing an outbreak of drug-resistant bacteria or antibiotic-related infections, it's not a bad idea to supplement with persuasion and education.
"One thing we haven't been able to address with this review is what keeps the intervention working," said Davey. "My hunch is that the persuasive things help with sustainability."
The researchers also found that programs centered on faster laboratory testing and computer decisionmaking aids helped to streamline processes and aided doctors in getting patients the right treatment.
The team concludes that future research should focus on comparing the different programs to each other. Davey added that more research into persuasive programs is also needed, along with information on the costs associated with these programs.
SOURCE: http://bit.ly/11YJD7D The Cochrane Library, online April 30, 2013.