Decrease of antibiotic use after the introduction of time-limited prescription forms

Objectives - The purpose of this study was to evaluate the impact of time-l imited prescriptions on the delivery of antibiotics in a university hospita l. Methods - In January 1998, we introduced a policy of time-limited prescript ion for selected antibiotics. Each prescription was limited to four days fo r empirical prescription and to seven days for documented infections. intra venous antibiotics subject to restriction were: amikacin, cefepime, sulbact am, ciprofloxacin, ceftazidime, fosfomycin, fusidic acid, ofloxacine, piper acilline, teicoplanin, tazocilline, imipenem, fluconazole, and vancomycin. Prescriptions were delivered only upon presentation of a pre-printed form s igned by a senior physician. Restricted antibiotic consumption data were su rveyed monthly Other antibiotics were surveyed yearly. Antibiotic use was m easured daily and expressed per 100 hospitalization days. Results - In-hospital activity increased by 1.9% for hospitalization days, and by 5.1% for admissions from 1997 to 1998. A 17.7% decrease of restricte d antibiotics and a 3% increase of nonrestricted antibiotics was observed A decrease in restricted antibiotics was balanced by an increase of non-rest ricted drugs of the same class. However; a 1.6% decrease of doses was obser ved The part of the budget dedicated to antibiotics decreased by 74%, and t he antibiotic cost per admission decreased by 11.9%. Conclusion - Quality of care did not seem affected as in-hospital length of stay and mortality were similar in both periods. Follow-up was not importa nt enough to demonstrate an effect of this policy on the isolation of drug resistant microorganisms. This study suggests that a simple, non-coercive m ethod can reduce the use of antibiotics in hospitals. (C) 1999 Editions sci entifiques et medicales Elsevier SAS.