Proper administration of antibiotics is a pervasive issue in medicine, both in terms of cost and of the unwanted development of drug-resistant bacteria such as Clostridium difficile. Researchers at the McGill University Health Center in Montreal examined the effectiveness of adopting an antibiotic “time-out” during treatment, which involves regularly re-evaluating the treatment strategy as clinical situations evolve.

The study, published in the Annals of Internal Medicine, showed that structured time-outs, using a locally developed online checklist, resulted in significantly decreased antibiotic costs coupled with decreased use of targeted medications. There was also a small decline in C. difficile infections.

The study involved 679 patients and was conducted over a period of 18 months on the internal medicine clinical teaching units at Montreal General Hospital. The time-out concept was introduced to physicians and trainees as an opportunity to review the indication, dose, and duration of antibiotic use when new clinical information became available.

The staff was also educated on antibiotic guidelines and participated in a twice-weekly structured review of all patients receiving antibiotics. This approach led to changes in doses, duration of treatment, and changes in the type of antibiotic prescribed, which in turn led to cost reductions and a small decrease in C. difficile.

The researchers calculated the new procedure reduced overall antibiotic costs from $149,743 (Canadian) in the year prior to the study to $80,319 after the audit – a savings of 46 percent. Of the savings, $54,150 was related to the Carbapenem class of antibiotics and $15,274 was due to other antibiotic classes.

“Our approach tied specific education about antibiotic use with a structural tool to review and guide this use,” senior author Louise Pilote, M.D., said. “This could translate into better prescribing practices. In general, physicians believed the process improved their comfort with antibiotics and provided clinical value.”

The study is available here.

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