ONE of the greatest threats to health is the overuse of antibiotics leading to disease-causing bacteria becoming resistant. The USA’s federal Centers for Disease Control and Prevention calls antibiotic resistance “one of the world’s most-pressing public health problems.”
A new study led by scientists at Dundee University has shown that to combat the overuse of antibiotics in hospitals, it is not the pills that need to change but those prescribing them.
Professor Peter Davey of Dundee University and his team set out to examine the prescribing behaviour of hospital doctors. Their major international study, known as the Cochrane Review, has identified effective and safe ways to reduce unnecessary use of antibiotics in hospitals.
According to Dundee University: “Inappropriate use is associated with increased resistance, and studies have shown that about half of the time, physicians in hospital are not prescribing appropriately.”
The Cochrane researchers – a global independent network of researchers, professionals, patients, carers and people interested in health – analysed studies from the US, Europe, Asia, South America, and Australia.
They looked at healthcare professionals who prescribed antibiotics to hospital in-patients receiving acute care and those undergoing planned surgery. This research was supported by grants from the Chief Scientist Office, Scottish Government and the British Society for Antimicrobial Chemotherapy.
Looking at 221 studies, involving 23,394 participants, the researchers assessed the effectiveness and safety of interventions designed to improve how medics prescribed antibiotics.
The interventions broadly fell into two categories – “restrictive” rules to make clinicians prescribe properly and “enabling” advice or feedback to help them make more-informed prescribing decisions.
The Cochrane reviewers found that interventions providing advice or feedback to prescribers were more effective at improving practices than those that did not include such information for clinicians.
In both cases, the aim was to ensure patients who were unlikely to benefit from antibiotics did not get them, while they were still used for patients who stood to benefit.
The interventions shorten the duration of antibiotic use from 11 days per patient to nine days, and are expected to reduce hospital stay from an average of 13 days per patient to 12 days.
Data showed the risk of death was 11 per cent in both treatment groups, suggesting reducing antibiotic use did not put patients at more risk.
The reviews concluded “guidelines and policies to pinpoint the patients in need of antibiotics have the greatest impact when doctors are supported to change their prescribing behaviour.”
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