Programmes 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
It also leaves patients vulnerable to secondary, opportunistic infections
like clostridium difficile - or "C. diff".
"Antibiotic resistance is recognised 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 organisation
that evaluates medical evidence.
For the new review, Davey and his colleagues searched medical research
databases for high-quality studies that evaluated whether hospital programmes 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
In the 89 studies from 19 different countries the researchers found, three
types of programme 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
Another set of programmes 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 decision making tools for doctors.
Overall, programmes that restricted a doctor's ability to prescribe antibiotics
were 32% more effective in the first month than those that tried to persuade and
Davey said 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 programmes also did a better job at reducing
drug-resistant bacteria and antibiotic-related infections, compared to the
"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 programmes caught up
in terms of their effectiveness, Davey said.
He added that while restrictive programmes 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 programmes centred on faster laboratory testing
and computer decision making 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 programmes to each other.
Davey added that more research into persuasive programmes is also needed, along
with information on the costs associated with these programmes.