Impact of a training intervention on use of antimicrobials in teaching hospitals

Seikh Farid Uddin Akter,Afia F Milly,Anthony J Smith,Richard D Heller

doi:10.3855/jidc.416

Abstract

Antimicrobials are often used inappropriately in paediatric wards of medical college hospitals in Bangladesh. Most of the antimicrobials are prescribed based on clinical grounds-signs and symptoms. This intervention study assessed the effectiveness of a training intervention on antimicrobials prescribing by physicians in paediatric wards of tertiary care level hospitals. This study was conducted at medical college hospitals in Bangladesh during the period from 1998 through 2000. The pre-intervention survey of antimicrobial use was conducted during 1998 in five hospitals. The post-intervention survey was conducted after the interactive training during the succeeding year in three of the original five hospitals, of which one was the intervention hospital and two control hospitals. A total of 3,466 admitted paediatric patients' treatment charts (2,171 in the pre-intervention and 1,295 in the post-intervention surveys) were reviewed. The most commonly used antimicrobials were ampicillin, gentamicin, amoxicillin, cloxacillin and ceftriaxone. Appropriate antimicrobial therapy for the most common infectious diseases, pneumonia and diarrhoea, increased by 16.4% and 56.8% respectively in the intervention hospital compared with the two control hospitals and these improvements were significant (p = < 0.001 and p = 0.002, for pneumonia and diarrhoea respectively). An interactive, focussed educational intervention, targeted at physicians, appears to have been effective in improving appropriate antimicrobial prescribing for the most common paediatric infectious diseases in a medical college hospital in Bangladesh.

Highlights

Antimicrobials are critical elements in the therapeutic armamentarium of modern medicine
Materials and Methods Two surveys of antimicrobial use were conducted at selected medical college hospitals in Bangladesh
While the difference in percentage of appropriate antimicrobial treatment of patients with pneumonia in the intervention hospital (I) before and after the educational intervention was obvious with a marked improvement after the intervention by 16.4%, difference in percentage of appropriate antimicrobial treatment of patients with diarrhoea was more obvious with a more marked improvement after the intervention by 56.8%

Summary

Introduction

Antimicrobials are critical elements in the therapeutic armamentarium of modern medicine These drugs are prescribed by various types of health care providers both in developed and developing countries, sometimes without adequate knowledge about the use and consequences of the use of these important therapeutic drugs [1]. Most of the antimicrobials are prescribed based on clinical grounds–signs and symptoms This intervention study assessed the effectiveness of a training intervention on antimicrobials prescribing by physicians in paediatric wards of tertiary care level hospitals. Conclusions: An interactive, focussed educational intervention, targeted at physicians, appears to have been effective in improving appropriate antimicrobial prescribing for the most common paediatric infectious diseases in a medical college hospital in Bangladesh

Objectives

Methods

Results

Conclusion