This study aimed to determine the
clinical course of patients and the quality of
antibiotic use using a systematic and unsolicited post-prescription
antibiotic review. Seven hundred and fifty-three adult patients receiving
antibiotic therapy for 3-5 days were randomized to receive either a post-prescription review by the
infectious disease physician (
IDP), followed by a recommendation to the attending physician to modify the prescription when appropriate, or no systematic review of the prescription. In the intervention group, 63.3% of prescriptions prompted
IDP recommendations, which were mostly followed by ward physicians (90.3%). Early
antibiotic modifications were more frequent in the intervention group (57.1% vs. 25.7%, p <0.0001), including stopping
therapy, shortening duration and de-escalating broad-spectrum
antibiotics.
IDP intervention led to a significant reduction of the median [IQR] duration of
antibiotic therapy (6 [4-9] vs. 7 days [5-9], p <0.0001). In-hospital mortality, ICU admission and new course of
antibiotic therapy rates did not differ between the two groups. Fewer patients in the intervention group were readmitted for relapsing
infection (3.4% vs. 7.9%, p 0.01). There was a trend for a shorter length of
hospital stay in patients suffering from
community-acquired infections in the intervention group (5 days [3-10] vs. 6 days [3-14], p 0.06). This study provides clinical evidence that a post-prescription
antibiotic review followed by unsolicited
IDP advice is effective in reducing
antibiotic exposure of patients and increasing the quality of
antibiotic use, and may reduce
hospital stay and relapsing
infection rates, with no adverse effects on other patient outcomes.