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Two lemons on the branch of a tree
Low hanging fruit

The Intervention.

In order to contain and rationalise antibiotic use, antibiotic policy guidelines were introduced in the hospital at various times during the period 2002 to 2010.

The time segments during which these were initiated are mentioned below:

  • Segment 1: July 2002 to February 2004 - This period was before the 2005 policy guidelines were introduced.
  • Segment 2: March 2004 to December 2005 - The Antibiotic Policy Committee met weekly from March 2004 with pharmacy, microbiology and clinical departments, and initiated preparation for guidelines. Guidelines were finalised and widely distributed from January 2005 as a small booklet.
  • Segment 3: January 2006 to December 2008 - There was no active guideline dissemination during this period.
  • Segment 4: January 2009 to December 2010 - Guidelines were revised, published and disseminated as a booklet from January 2009 onwards till December 2010. Unlike Segment 2, there was no preparatory phase with clinical departments.

This image is a graph with four segments.  Segment 1 = July 2002 - Feb 2004 before guideline booklet disseminated; Segment 2 = Feb 2004 - Dec 2005 with stakeholder involved guideline booklet dissemination; Segment 3 = Dec 2005 to Dec 2008 no active guideline booklet dissemination and Segment 4 = Dec 2008 to Dec 2010 revised guideline booklet dissemination. The graph shows a rising trend in antibiotic use across all four segments from 60 DDD per 100 bed days in 2002 to around 90 DDD per 100 bed days in 2010.

As you can see from Dr Chandy’s graph the introduction of policy guidelines in Segment 2 and 4 contained the rising antibiotic use but did not effectively reverse the upward trend Consider the following questions:

  • What was the essential difference between guidelines introduced in Segment 2 and Segment 4?
  • Why do you think the guidelines introduced did not effectively reverse the upward trend?
  • How could the guidelines have been improved upon for more effectiveness?
  • Could any other strategy have been employed to supplement the effect of guidelines?

You may wish to post your answers in the comments section below.

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This article is from the free online course:

Antimicrobial Stewardship: Managing Antibiotic Resistance

University of Dundee

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