User-friendly guidelines decreased antibiotic use in Quebec

The implementation of an educational program with user-friendly guidelines targeting physicians and pharmacists reduced outpatient antibiotic use in Quebec, according to new findings published in Clinical Infectious Diseases.

In collaboration with the Quebec Ministry of Health, Karl Weiss, MD, FRCPC, of the University of Montreal, and colleagues implemented an educational program in 2005 to promote better use of antibiotics. With the use of a bundle approach, 11 guidelines were issued targeting the most common infections in the outpatient setting: upper and lower respiratory tract infections, urinary tract infections and Clostridium difficile infections in adults and children.

“Clinical information was provided along with antibiotic recommendations emphasizing proper antibiotic regimens, not using antibiotics when viral infections were suspected, and prescribing the shortest possible duration of treatment,” the researchers wrote.

Data were then pooled from the Intercontinental Medical Statistics database to assess the effect of the education program on Quebec’s total outpatient prescriptions per 1,000 inhabitants and cost of antibiotic prescriptions. Researchers then compared these results with nine other Canadian provinces.

Compared with the previous year, the total number of outpatient antibiotic prescriptions decreased by 4.2% in Quebec (P=.0002) after the guidelines were disseminated, whereas the number of prescriptions increased by 6.5% elsewhere in Canada.

Further, the cost of antibiotics decreased by $134.5/1,000 inhabitants in Quebec compared with the rest of Canada (P=.054), the researchers reported.

“It is possible to decrease antibiotic consumption when physicians, pharmacists, state governments, etc., are working together for a common goal,” Weiss said in a press release. “This is the key to success: having everybody involved and speaking with a common voice.

“Simple, short, easy-to-use guidelines have an impact on physicians when they are readily available,” he said. “The Web is an increasingly important tool to reach our audience and should now be used as such in the future. With hand-held electronic devices available for all health care professionals, these downloadable guidelines can be accessed and used at any time and any circumstance.”

For more information:

• Weiss K. Clin Infect Dis. 2011;doi:10.1093/cid/cir409.

Disclosure: Dr. Weiss received research grants from Abbott, Bayer Health Care, GlaxoSmithKline, Merck, Optimer Pharma, Pfizer, Roche, and Valorisation-Recherche Quebec, Government of Canada, and has received payment for consulting work from Pfizer.

Weiss and colleagues highlight the role of education in any stewardship program. Previous studies have shown educational initiatives to be an essential element of hospital-based stewardship programs and in this study, the positive benefits of this approach were demonstrated in the community setting — a much less controlled environment. While a 4.1% relative decrease in antimicrobial use may appear small, this is actually a big effect in an arena where changing prescribing patterns has proven difficult. Antimicrobial stewardship is a success because providers want to do the right thing, but often the campaigns advocating for limiting antibiotic use are not accompanied by guidelines for appropriate use and duration. In the education provided throughout Quebec, the message to limit antimicrobial use was tied with specific guidance on where, when and how to use antibiotics appropriately. I believe this combined educational approach helped these investigators achieve their objective. It is also important to note that in addition to the education provided to providers as part of this initiative, education was also occurring at the population level during this time. Studies like this showing that educational campaigns can bend the curve of antibiotic use, will hopefully lend additional support to more widespread educational campaigns.

– Elizabeth Dodds Ashley, PharmD, BCPS

Infectious Diseases News Editorial Board member

Disclosure: Dr. Dodds Ashley reports no relevant financial disclosures.

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