Review - Reviewer's Assessment

1. Short summary / abstract
The review looks at the effectiveness of professional interventions that alone or in combination are successful in promoting prudent antibiotic prescribing to hospital inpatients and evaluates the impact these interventions have on reducing the incidence of antimicrobial resistant pathogens or CDAD and the impact on clinical outcomes.
To determine what improved prescribing, 66 studies were analysed from North America and the United Kingdom.
Six studies tested methods increasing antibiotics around time of surgery
The other sixty studies tested persuasive and restrictive methods to reduce unnecessary antibiotic usage
Conclusions were that both methods improved prescribing, decreased infection rates, deaths, illness and length of stay but that restrictive methods appeared to have a greater effect than persuasive methods


2. What question is the document addressing?
The review looks at how antibiotics prescribing by physicians working in hospitals can be improved in an attempt to reduce antimicrobial resistance and CDAD

3. Type of study
Systematic review

4. Methods valid & appropriate?
Yes

Comments:
Up to 50% of antibiotic usage in hospitals is inappropriate – the review is an attempt at improving how antibiotics are prescribed

5. Results / recommendations reliable?
Yes: Searches undertaken from EPOC, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE (1980-2003) additional studies from bibliographies of retrieved articles

6. Any major problems and biases?
More studies are needed to assess the clinical benefits of the two main methods reviewed.

7. Any other important / relevant studies which confirm or contradict?
References reviewed, relevant graphs and tables included in review document.
Systematic Review of Antimicrobial Drug Prescribing in Hospitals http://www.cdc.gov/ncidod/EID/vol12no02/05-0145.htm


8. Keywords
antibiotic prescribing Clostridium difficile clostridium difficile associated diarrhoea (CDAD) hospital acquired infection antimicrobial resistance



Reviewer's Details:

Name:Sue Wiseman
Post:Nurse Consultant –Infection Control, DH
Affiliations
(Society / Organisation / Advisory Committee):
Member Advisory Committee on Dangerous Pathogens
Health Protection Adviser Royal College of Nursing P/T
Member Infection Control Nurses Association


*** Note: These are the views of a professional expert rather than an official statement from his or her society, organisation or advisory committee.






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