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. 2014 Nov 14;2014:1115-24.
eCollection 2014.

An Algorithm Using Twelve Properties of Antibiotics to Find the Recommended Antibiotics, as in CPGs

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An Algorithm Using Twelve Properties of Antibiotics to Find the Recommended Antibiotics, as in CPGs

R Tsopra et al. AMIA Annu Symp Proc. .
Free PMC article

Abstract

Background: Clinical Decision Support Systems (CDSS) incorporating justifications, updating and adjustable recommendations can considerably improve the quality of healthcare. We propose a new approach to the design of CDSS for empiric antibiotic prescription, based on implementation of the deeper medical reasoning used by experts in the development of clinical practice guidelines (CPGs), to deduce the recommended antibiotics.

Methods: We investigated two methods ("exclusion" versus "scoring") for reproducing this reasoning based on antibiotic properties.

Results: The "exclusion" method reproduced expert reasoning the more accurately, retrieving the full list of recommended antibiotics for almost all clinical situations.

Discussion: This approach has several advantages: (i) it provides convincing explanations for physicians; (ii) updating could easily be incorporated into the CDSS; (iii) it can provide recommendations for clinical situations missing from CPGs.

Figures

Figure 1.
Figure 1.
Method 2 – Exclusion of antibiotics according to a sequence of questions (see the correspondence of properties A to L in Tables 1 and 2). Example of seven antibiotics, for pharyngitis in adults with penicillin allergy and without a contraindication for beta-lactams. All seven antibiotics were present in the initial list of candidate antibiotics. Two antibiotics did not have all the necessary properties and were excluded from the list (“amoxicillin” for property F, and “azithromycin” for property E). The other five antibiotics were considered appropriate. For the six preference properties, 720 sequences of questions are possible by permutation of the properties. The final list of antibiotics obtained depends on the order of questions in the sequence. We illustrate the results for two sequences: sequence 1 generated a list of three antibiotics (“cefuroxime axetil’, “cefotiam hexetil”, and “cefpodoxime proxetil”), whereas sequence 2 yielded one antibiotic (“cefaclor”). As the list obtained with sequence 1 corresponds to the gold standard (i.e. the list of antibiotics recommended in CPGs), sequence 1 of method 2 is considered “satisfactory” for this clinical situation, whereas sequence 2 is not.

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