Impact of web-based antimicrobial approval system on broad-spectrum cephalosporin use at a teaching hospital

Objective: To achieve sustained. improvement in use of cefotaxime and ceftriaxone (CEFX) in a major teaching hospital, as measured against national antibiotic guidelines. Design and setting: Pre- and post-intervention survey of CEFX use in the Royal Melbourne Hospital, a tertiary hospital in Melbourne, Victoria. Intervention: Web-based antimicrobial approval system linked to national antibiotic guidelines was developed by a multidisciplinary team and implemented in March 2001. Main outcome measures: Change in rate of CEFX use (defined daily doses [DDDs] per 1000 acute occupied bed days) over 8 months pre- and 15 months postintervention; concordance of indication for CEFX with national antibiotic guidelines pre- and post-intervention. Results: CEFX use decreased from a mean of 38.3 DDDs/1000 bed days preintervention to 15.9, 18.7 and 21.2 DDDs/1 000 bed days at 1, 4 and 15 months postintervention. Concordance with national antibiotic guidelines rose from 25% of courses pre-intervention to 51% within 5 months post-intervention (P< 0.002). Gentamicin use also increased, from a mean of 30.0 to 48.3 DDDs/1 000 bed days (P= 0.0001). Conclusion: The web-based antimicrobial approval system achieved a sustained reduction in CEFX use over 15 months as well as increased prescribing concordance with antibiotic guidelines. It has potential for linking to electronic prescribing and for wider use for other drugs, as well as for research into the epidemiology of antibiotic use.