This paper looks at the effectiveness of a new tool for antibiotic stewardship. Citation, extracts and comment from me below.
--
Comment: New tools for antibiotic stewardship: a lesson for prescribers, researchers, or policy makers?
Evelina Tacconelli et al. Lancet Infectious Diseases
Published:October 04, 2022 DOI:https://doi.org/10.1016/S1473-3099(22)00546-1
'Martin J Llewelyn and colleagues report the results of a stepped-wedge cluster-randomised trial evaluating the efficacy of the antibiotic review kit for hospitals (ARK-Hospital) programme in safely reducing antibiotic consumption. The intervention targeted the medical wards of 39 UK facilities over a 4-year period. The antibiotic review kit (ARK) intervention was primarily based on categorising diagnostic uncertainty relative to the infection status, followed by a systematic re-evaluation of prescription at 48–72 h. The intervention reached a reduction in total antibiotic consumption of 4·8% defined daily doses per acute medical admission per year, with no relevant effect on length of hospital stay and an inconsistent effect on mortality...
The study results suggest that hospitals with higher adherence to the educational, audit, and feedback activities had a greater decrease in antibiotic consumption than did hospitals with lower adherence to these activities. From the point of view of the prescriber, the most important message is, therefore, the importance of behavior change as a crucial element for improving the quality of antibiotic prescribing...
From the perspective of the policy maker, there are important lessons to learn. Notably, the essential element of the implementation process was creating a local team led by a representative who would champion the intervention and engage local prescribers in each hospital. Importantly, if such an intervention is to be transferred to low-resource settings with few infection specialists or advanced information technology systems, the fact that neither the functional role of the champion nor whether prescribing systems were electronic or paper based made a difference to the success of the intervention is imperative. To our understanding, no further structural or economic resources were needed from the hospital to join the trial. So, once again, dedicated time and personnel for conducting antibiotic stewardship is the core step for starting a successful programme...
It would be interesting to send these results to relevant national policy makers and ask if the new evidence will have an effect on their antibiotic strategic plans for the next year. We expect that most policy makers would definitively say yes, however, we are pessimistic that, come next year, few would have acted on their promises. We cannot have it both ways: on the one hand bemoan the scarcity of high-quality studies on hospital antibiotic stewardship interventions and, on the other hand, fail to implement the findings of excellent studies when they show a positive effect.
--
COMMENT: The research was undertaken in the UK and might not be applicable to low-resource settings. A key factor in low-resource settings is the lack of availability of reliable information to guide prescribing. Until this basic requirement is addressed, more sophisticated tools are likely to be irrelevant.
Best wishes, Neil
Joint Coordinator HIFA Project on Information for Prescribers and Users of Medicines http://www.hifa.org/projects/prescribers-and-users-medicines
Let's build a future where every person has access to reliable healthcare information and is protected from misinformation - Join HIFA: www.hifa.org
HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health movement (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information. HIFA is administered by Global Healthcare Information Network, a UK based non-profit in official relations with the World Health Organization.
Twitter: @hifa_org neil@hifa.org
