Improving appropriateness of antibiotic therapy: randomized trial of an intervention to foster reassessment of prescription after 3 days

J Antimicrob Chemother. 2004 Jun;53(6):1062-7. doi: 10.1093/jac/dkh236. Epub 2004 May 5.


Objectives: Reassessment of ongoing antibiotic therapy is an important step towards appropriate use of antibiotics. This study was conducted to evaluate the impact of a short questionnaire designed to encourage reassessment of intravenous antibiotic therapy after 3 days.

Patients and methods: Patients hospitalized on the surgical and medical wards of a university hospital and treated with an intravenous antibiotic for 3-4 days were randomly allocated to either an intervention or control group. The intervention consisted of mailing to the physician in charge of the patient a three-item questionnaire referring to possible adaptation of the antibiotic therapy. The primary outcome was the time elapsed from randomization until a first modification of the initial intravenous antibiotic therapy. It was compared within both groups using Cox proportional-hazard modelling.

Results: One hundred and twenty-six eligible patients were randomized in the intervention group and 125 in the control group. Time to modification of intravenous antibiotic therapy was 14% shorter in the intervention group (adjusted hazard ratio for modification 1.28, 95% CI 0.99-1.67, P = 0.06). It was significantly shorter in the intervention group compared with a similar group of 151 patients observed during a 2 month period preceding the study (adjusted hazard ratio 1.17, 95% CI 1.03-1.32, P = 0.02).

Conclusion: The results suggest that a short questionnaire, easily adaptable to automatization, has the potential to foster reassessment of antibiotic therapy.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Infections / drug therapy*
  • Bacterial Infections / microbiology
  • Decision Support Systems, Clinical
  • Drug Prescriptions / standards*
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Quality Assurance, Health Care
  • Surveys and Questionnaires
  • Treatment Outcome


  • Anti-Bacterial Agents