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  Table of Contents  
COMMENTARY
Year : 2015  |  Volume : 33  |  Issue : 2  |  Page : 260-261
 

Feedback to clinicians on antibiotic prescription habits: How effective are they?


Department of Microbiology, Manipal Hospital, Bangalore, Karnataka, India

Date of Submission06-Oct-2014
Date of Acceptance31-Dec-2014
Date of Web Publication10-Apr-2015

Correspondence Address:
S Joshi
Department of Microbiology, Manipal Hospital, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.154868

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How to cite this article:
Joshi S. Feedback to clinicians on antibiotic prescription habits: How effective are they?. Indian J Med Microbiol 2015;33:260-1

How to cite this URL:
Joshi S. Feedback to clinicians on antibiotic prescription habits: How effective are they?. Indian J Med Microbiol [serial online] 2015 [cited 2019 Dec 15];33:260-1. Available from: http://www.ijmm.org/text.asp?2015/33/2/260/154868


All of us in the medical fraternity are well aware of the increasing resistance rate among bacteria and the diminishing pipeline of antibiotics, with no light visible at the end of the tunnel. What we do have in our hands is the ability to use antibiotics prudently. One of the ways in appropriate antibiotic usage is to give a feedback to the clinicians. The authors in this issue's article "Feedback to clinicians on antibiotic prescription habits-how effective are they?" have shown that passive intervention by feedback to clinicians failed to make a change in the prescribing habits of clinicians. [1] The authors did an intervention by providing resistance rates and antibiotic prescribing patterns to the clinicians and assessed the effect on clinical prescribing practices. They have concluded that, in their setting, other measures including direct interaction with the clinicians may be more effective in reducing antibiotic consumption. Similarly, Cisneros et al., felt that passive educational strategies are only marginally effective in changing antimicrobial practices and they have advocated interactive educational measures for effectiveness. They have shown a reduction in antimicrobial consumption using direct counselling and feedback methods. [2] Ghafur et al., have shown that with a strict antibiotic policy and strict infection control strategies, along with education and feedback, the prevalence of carbapenem-resistant Enterobacteriaceae had reduced as compared to the previous year. The usage of carbapenem antibiotics had also dropped during the study period. [3]

Antimicrobial stewardship is a rational, systematic approach to improving appropriate use of antimicrobials to achieve optimal outcomes. [4] Antibiotic stewardship programmes (ASPs) encompass a number of elements including prospective audit and feedback, formulary restriction and preauthorization, development of antibiotic guidelines based on local antibiograms, de-escalation and optimizing doses and education. [5] The use of information technology in the form of electronic records and clinical decision support systems have a great potential for promoting appropriate antimicrobial use. The pro-active role of a medical microbiologist in antibiotic stewardship programmes including preparation of local antibiograms, planning empiric antibiotic therapy and implementing good quality control measures in the laboratory cannot be re-emphasised. [6]

Along with planning ASPs, the outcome measures would need to be periodically evaluated. Improvement in clinical outcomes, decreased antibiotic consumption in terms of daily defined doses and antibiotic resistance patterns are some of the key outcome determinants. [7] A multipronged approach would be needed as part of ASPs in conjunction with good infection control practices to curb antimicrobial resistance and to decrease antibiotic consumption. The Indian Council of Medical Research (ICMR) initiated a programme on antibiotic stewardship, prevention of infection and control (ASPIC) to raise awareness and to train participants on antibiotic stewardship and infection control. [8] While education does have a key role in hospitals, the inclusion of antimicrobial resistance and its impact and infection control practices as part of curriculum at the undergraduate level of medical education would create awareness among the soon-to-be doctors and (one hopes) would lead to rational antibiotic use in the coming years.

 
 ~ References Top

1.
Impact of informational feedback to clinicians on antibiotic prescribing rates in a tertiary care hospital in Delhi. Indian J Med Microbiol 2015:255-259.  Back to cited text no. 1
    
2.
Cisneros JM, Neth O, Gil-Navarro MV, Lepe JA, Jiminex-Parrilla F, Cordero E, et al. PRIOAM team. Global impact of an educational antimicrobial stewardship programme on prescribing practice in a tertiary hospital centre. Clin Microbiol Infect 2014;20:82-8.  Back to cited text no. 2
    
3.
Ghafur A, Nagvekar V, Thilakavathy S, Chandra K, Gopalakrishnan R, Vidyalakshmi P. Apollo Speciality Hospital, Chennai, India. "Save Antibiotics, Save lives": An Indian success story of infection control through persuasive diplomacy. Antimicrob Resist Infect Control 2012;1:29.  Back to cited text no. 3
    
4.
Owens RC Jr. Antimicrobial stewardship: Concepts and strategies in the 21 st century. Diagn Microbiol Infect Dis 2008;61:110-28.  Back to cited text no. 4
    
5.
Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159-77.  Back to cited text no. 5
    
6.
Kapil A. India needs an implementable antibiotic policy. Indian J Med Microbiol 2013;31:111-3.  Back to cited text no. 6
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7.
McGregor JC, Furuno JP. Optimizing research methods used for evaluation of antimicrobial stewardship programs. Clin Infect Dis 2014;59:S185-92.  Back to cited text no. 7
    
8.
Chandy SJ, Michael JS, Veeraraghavan B, Abraham OC, Bachhay SS, Kshirsagar NA. ICMR programme on Antibiotic Stewardship, Prevention of Infection and Control (ASPIC). Indian J Med Res 2014;139:226-30.  Back to cited text no. 8
[PUBMED]  Medknow Journal  




 

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