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Whats New in the
Patient Safety World
July 2024
Feedback Improves
Antibiotic Prescribing in Patients 65 and Older
Were always looking for ways to improve antibiotic
stewardship. Schwartz et al. found that peer comparison audit and feedback
letters significantly reduced overall antibiotic prescribing for patients aged
65 years and older in Ontario, Canada (Schwartz 2024). A
letter was mailed to primary care physicians with peer comparison antibiotic
prescribing feedback compared with the control group who did not receive a
letter. At six months, there was a significant 5% relative reduction in the overall
antibiotic prescribing rate compared with physicians in the control group. There
was an 11% relative reduction in unnecessary antibiotic prescriptions, 15%
relative reduction in antibiotic durations more than seven days, and a 6%
relative reduction on broad spectrum antibiotic prescribing. They also found
that there was no additional value in adjusting for case mix or emphasizing
potential harms of antibiotic prescribing in the messaging. The authors
conclude that antibiotic prescribing audit and feedback is a scalable and
effective intervention and should be a routine quality improvement initiative
in primary care.
The accompanying editorial (Powers 2024) notes that research
shows a third of US antibiotic prescriptions are unnecessary and this figure is
up to seven in 10 prescriptions in other countries. But Powers urges caution in
interpretation of the study, citing multiple limitations. He notes that lower
prescribing does not necessarily mean better prescribing and that the antimicrobial
prescription rate is not a direct measure of patients health status. He notes
the primary reason for appropriate prescribing is not solely to prevent
antimicrobial resistance but to improve patient outcomes. For example, the more
common and more proximal harm to patients is from direct adverse effects of antimicrobials.
He argues that the priority for appropriate prescribing and the outcomes
measured in future stewardship studies should be direct patient outcomes, and
that showing direct benefits for patients would justify the cost and implementation
of such programs before they are routinely recommended.
Some of our prior
columns on antibiotic stewardship:
- October 14, 2014 Antibiotic Stewardship
- November 2015 Medications Most Likely to Harm the Elderly Are
- July 2016 NQF/CDC Guideline on
Antibiotic Stewardship
- August 2016 Some Reassurance on
Antibiotic Stewardship
- November 2016 C. Diff and Your
Predecessors Room
- December 2016 Update on Ambulatory
Antibiotic Stewardship
- July 2017 Antibiotics and Adverse
Events
- July 2019 Dental Prescribing
Called Into Question
- July 21, 2020 Is This Patient
Allergic to Penicillin?
- March 30, 2021 Need for Better
Antibiotic Stewardship
- August 2021 Antibiotic Stewardship
in Pediatrics
- May 24, 2022 Requiring Indication
for Antibiotic Prescribing
- August 2022 Resistant Infections Up
During COVID-19 Pandemic
·
April 23, 2024 Prompting Improves
Antibiotic Stewardship
References:
Schwartz KL, Shuldiner J, Langford
BJ, et al. Mailed feedback to primary care physicians on antibiotic prescribing
for patients aged 65 years and older: pragmatic, factorial randomised
controlled trial. BMJ 2024; 385: e079329
https://www.bmj.com/content/385/bmj-2024-079329
Powers J H. Antimicrobial stewardship. BMJ 2024; 385: q1170
https://www.bmj.com/content/385/bmj.q1170
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