Efficacy of educational intervention on reducing the inappropriate use of oral third-generation cephalosporins

Abstract

This study aimed to evaluate the efficacy of an educational intervention on reducing the inappropriate use of oral third-generation cephalosporins, the prevalence of resistant bacteria, and clinical outcomes.Methods: A before-after study was conducted to compare the data for one year before and after intervention at a Japanese university hospital. Educational intervention included lectures for all medical staff on oral antibiotics and educational meetings with each medical department. The primary outcome was the use of oral thirdgeneration cephalosporins in inpatients as measured by the monthly median days of therapy (DOTs) per 1000 patient days. Secondary outcomes included the use of each oral antibiotic in inpatients and outpatients, proportion of ß-lactamase-nonproducing ampicillin-resistant Haemophilus influenzae (BLNAR), penicillinresistant Streptococcus pneumoniae (PRSP) and extended-spectrum β-lactamase producing Escherichia coli (ESBLEC), the incidence of hospital-acquired Clostridioides difficile infection (HA-CDI), and hospital mortality.Results: The use of oral third-generation cephalosporins in inpatients was significantly decreased after intervention [DOTs (interquartile range): 24.2 (23.5-25.1) vs. 3.7 (0.0-7.1), P < 0.001], and the value in outpatients was also decreased significantly. The use of fluoroquinolones and macrolides did not increase after intervention. The proportion of BLNAR, PRSP and ESBLEC did not change significantly during the study period. The incidence of HA-CDI was significantly decreased, and hospital mortality did not change after intervention. 4Conclusion: Educational intervention was effective in reducing the use of oral third-generation cephalosporins without increasing the use of broad-spectrum antibiotics and worsening clinical outcome. The prevalence of resistant bacteria did not change during the study period.

Effect of educational intervention on the appropriate use of oral antimicrobials in oral and maxillofacial surgery: a retrospective secondary data analysis

“…Moreover, macrolides and quinolones prescriptions in 2018 were much less than that in 2013, because of the adoption of the National Action Plan on AMR in Japan [6]. The introduction of educational intervention by the AST was considered to have contributed significantly in this regard [24]. In addition, we consider that these results reflect the high compliance following 3); and the total amount of oral antibiotics (median 0.7).…”

“…For inpatients, there were no prescriptions of oral third-generation cephalosporins in our department in 2018. Thus, oral third-generation cephalosporins were removed from the formulary for inpatients in our hospital, and the educational intervention by the AST contributed significantly in this regard [24]. Penicillins, which are highly effective against odontogenic infection, have supplanted oral third-generation cephalosporins in terms of the appropriate use of antibiotics [18,19].…”

“…The amount of oral antibiotics used was evaluated by recording the days of therapy (DOTs) per 1,000 patient-days. For outpatients, the total number of patients in each period was used as the denominator, and DOTs per 1,000 outpatients were calculated according to previous reports [23,24]. Further, to facilitate visual comparisons, we have expressed antimicrobial use in 2013 and 2018 as the ratio of DOTs of them (the ratio is 1: "2018 = 2013"; less than 1: "2018 < 2013"; greater than 1: "2018 > 2013").…”

“…The AST consisted of infectious disease physicians, pharmacists, nurses, and microbiology technologists. In addition, oral third-generation cephalosporins (cefcapene-pivoxil, cefditoren-pivoxil, cefteram-pivoxil, and cefdinir) were removed from the formulary for inpatients in our hospital since January 2018 [24]. The educational intervention included lectures for all medical staff on the appropriate use of oral antibiotics as well as educational meetings with each of the medical departments from July to August 2017 [24].…”

“…In addition, oral third-generation cephalosporins (cefcapene-pivoxil, cefditoren-pivoxil, cefteram-pivoxil, and cefdinir) were removed from the formulary for inpatients in our hospital since January 2018 [24]. The educational intervention included lectures for all medical staff on the appropriate use of oral antibiotics as well as educational meetings with each of the medical departments from July to August 2017 [24]. Even though the independent strategy meeting was not conducted in our department (Oral and Maxillofacial Surgery Department), the AST directives were strictly adhered to (Fig.…”