HOSPITAL ANTIBIOTIC PRESCRIBING SUCCESSFULLY MODIFIED BY IMMEDIATE CONCURRENT FEEDBACK

1. To determine the effectiveness of ongoing immediate concurrent feed back (ICF) in minimizing 'inappropriate' sultamicillin or co-amoxiclav prescribing via the parenteral route (i.e. when the oral route was ac cessible and not contraindicated), a prospective controlled audit was carried out on hospital inpatients over a 20 month period. 2 After an education programme to promote oral rather than unnecessary intravenou s (i.v.) use of sultamicillin, co-amoxiclav and certain other drugs, a n ongoing ICF strategy was instituted. 3 ICF entailed issue of memos o n the following day to prescribers of i.v. sultamicillin or co-amoxicl av for inpatients in whom this route was deemed 'inappropriate', by a specially trained nurse using strict objective criteria. The memos rec ommended oral prescribing (particularly of co-amoxiclav, currently the less expensive alternative). 4 After starting ICF, there were consist ent, clinically and statistically significant reductions in the monthl y proportions of (i) admissions prescribed i.v. sultamicillin or co-am oxiclav (38% P<0.001), (ii) those in whom the route was 'inappropriate ' (75%, P<0.001), and (iii) corresponding ratios of i.v./oral usage an d expenditure, oral sultamicillin/co-amoxiclav usage and expenditure, as well as total and per admission expenditure on i.v. forms (greater than or equal to 43%, P<0.01). 5 For i.v. cefuroxime (for which there was no ICF) and its oral counterpart cefuroxime-axetil, there were no comparable changes in usage or expenditure. 6 This simple, ongoing ICF strategy was effective and well accepted; estimated net monthly savin gs being HK$26-30,000.