University of Dundee Interventions to improve antibiotic prescribing practices for hospital inpatients Davey, Peter; Marwick, Charis A.; Scott, Claire L.; Charani, Esmita; McNeil, Kirsty; Brown, Erwin Published in: Cochrane Database of Systematic Reviews DOI: 10.1002/14651858.CD003543.pub4 Publication date: 2017 Document Version Publisher's PDF, also known as Version of record Link to publication in Discovery Research Portal Citation for published version (APA): Davey, P., Marwick, C. A., Scott, C. L., Charani, E., McNeil, K., Brown, E., Gould, I. M., Ramsay, C. R., & Michie, S. (2017). Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database of Systematic Reviews, 2017(2), 1-368. [CD003543]. https://doi.org/10.1002/14651858.CD003543.pub4 General rights Copyright and moral rights for the publications made accessible in Discovery Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from Discovery Research Portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain. • You may freely distribute the URL identifying the publication in the public portal. Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Download date: 24. Sep. 2021 Cochrane Database of Systematic Reviews Interventions to improve antibiotic prescribing practices for hospital inpatients (Review) Davey P, Marwick CA, Scott CL, Charani E, McNeilK, Brown E, Gould IM, Ramsay CR, Michie S Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, Gould IM, Ramsay CR, Michie S. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD003543. DOI: 10.1002/14651858.CD003543.pub4. www.cochranelibrary.com Interventions to improve antibiotic prescribing practices for hospital inpatients (Review) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 3 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . ..... 4 BACKGROUND .................................... 8 OBJECTIVES ..................................... 8 METHODS ...................................... 8 RESULTS....................................... 13 Figure1. ..................................... 14 Figure2. ..................................... 16 Figure3. ..................................... 18 Figure4. ..................................... 18 Figure5. ..................................... 19 Figure6. ..................................... 20 Figure7. ..................................... 21 Figure8. ..................................... 22 Figure9. ..................................... 22 Figure10. ..................................... 23 Figure11. ..................................... 24 Figure12. ..................................... 25 Figure13. ..................................... 26 Figure14. ..................................... 27 DISCUSSION ..................................... 28 AUTHORS’CONCLUSIONS . 31 ACKNOWLEDGEMENTS . 32 REFERENCES ..................................... 32 CHARACTERISTICSOFSTUDIES . 49 DATAANDANALYSES. 315 Analysis 1.1. Comparison 1 Effectiveness: Prescribing outcomes from RCTs of interventions to reduce unnecessary antibiotic use, Outcome 1 Dichotomous outcomes, increase in desired practice. 317 Analysis 1.2. Comparison 1 Effectiveness: Prescribing outcomes from RCTs of interventions to reduce unnecessary antibiotic use, Outcome 2 Dichotomous outcomes, all RCTs with results of cluster RCTs adjusted by inflation factor. .................................... 319 Analysis 1.3. Comparison 1 Effectiveness: Prescribing outcomes from RCTs of interventions to reduce unnecessary antibiotic use, Outcome 3 Dichotomous outcomes, low or medium ’Risk of bias’ studies only. 321 Analysis 1.4. Comparison 1 Effectiveness: Prescribing outcomes from RCTs of interventions to reduce unnecessary antibiotic use, Outcome 4 Continuous outcomes, duration of all antibiotic treatment (days). 322 Analysis 1.5. Comparison 1 Effectiveness: Prescribing outcomes from RCTs of interventions to reduce unnecessary antibiotic use, Outcome 5 Continuous outcomes, duration of all antibiotic treatment with results of cluster RCTs adjusted by inflation factor. 323 Analysis 1.6. Comparison 1 Effectiveness: Prescribing outcomes from RCTs of interventions to reduce unnecessary antibiotic use, Outcome 6 Continuous outcomes, low or medium ’Risk of bias’ studies only. 324 Analysis 1.7. Comparison 1 Effectiveness: Prescribing outcomes from RCTs of interventions to reduce unnecessary antibiotic use, Outcome 7 Continuous outcome, consumption of targeted antibiotic only, standardised mean reduction (original outcome cost, days or DDD). 325 Analysis 2.1. Comparison 2 Adverse effects: Clinical outcomes from RCTs of interventions to reduce unnecessary antibiotic use, Outcome 1 Mortality, all RCTs. 326 Analysis 2.2. Comparison 2 Adverse effects: Clinical outcomes from RCTs of interventions to reduce unnecessary antibiotic use, Outcome 2 Mortality, all RCTs with results of cluster RCTs adjusted by inflation factor. 328 Analysis 2.3. Comparison 2 Adverse effects: Clinical outcomes from RCTs of interventions to reduce unnecessary antibiotic use, Outcome 3 Mortality, low or medium ’Risk of bias’ RCTs. ............... 330 Interventions to improve antibiotic prescribing practices for hospital inpatients (Review) i Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 2.4. Comparison 2 Adverse effects: Clinical outcomes from RCTs of interventions to reduce unnecessary antibiotic use, Outcome 4 Length of stay, all RCTs. 331 Analysis 2.5. Comparison 2 Adverse effects: Clinical outcomes from RCTs of interventions to reduce unnecessary antibiotic use, Outcome 5 Length of stay, all RCTs with results of cluster RCTs adjusted by inflation factor. 332 Analysis 2.6. Comparison 2 Adverse effects: Clinical outcomes from RCTs of interventions to reduce unnecessary antibiotic use, Outcome 6 Length of stay, low or medium ’Risk of bias’ RCTs only. ............. 333 Analysis 3.1. Comparison 3 Adverse effects: Clinical outcomes of interventions targeting antibiotic choice, Outcome 1 Mortality for trial patients. 334 Analysis 3.2. Comparison 3 Adverse effects: Clinical outcomes of interventions targeting antibiotic choice, Outcome 2 Length of stay for trial patients. 335 Analysis 4.1. Comparison 4 Adverse effects: Clinical outcomes of interventions targeting antibiotic exposure, Outcome 1 Mortality for trial patients. 336 Analysis 4.2. Comparison 4 Adverse effects: Clinical outcomes of interventions targeting antibiotic exposure, Outcome 2 Length of stay for trial patients. 337 Analysis 5.1. Comparison 5 Modifiers of intended effect: Comparison of enabling interventions with and without feedback, Outcome1Enablementwithfeedback. 338 Analysis 5.2. Comparison 5 Modifiers of intended effect: Comparison of enabling interventions with and without feedback, Outcome 2 Enablement without feedback. 339 ADDITIONALTABLES. 339 APPENDICES ..................................... 346 WHAT’SNEW..................................... 364 HISTORY....................................... 365 CONTRIBUTIONSOFAUTHORS . 366 DECLARATIONSOFINTEREST . 367 SOURCESOFSUPPORT . 367 DIFFERENCES BETWEEN PROTOCOL AND REVIEW . .... 367 INDEXTERMS .................................... 368 Interventions to improve antibiotic prescribing practices for hospital inpatients (Review) ii Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Intervention Review] Interventions to improve antibiotic prescribing practices for hospital inpatients Peter Davey1, Charis A Marwick2, Claire L Scott3, Esmita Charani4, Kirsty McNeil5, Erwin Brown6, Ian M Gould7, Craig R Ramsay 8, Susan Michie9 1Population Health Sciences, University of Dundee, Dundee, UK. 2Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, UK. 3Scottish Dental Clinical Effectiveness Programme, NHS Education for Scotland, Dundee, UK. 4NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK. 5School of Medicine, University of Dundee, Dundee, UK. 6No affiliation, Bristol, UK. 7Department of Medical Microbiology, Aberdeen Royal Infirmary, Aberdeen, UK. 8Health Services Research Unit, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK. 9Research Department of Primary Care and Population Health, University College London, London, UK Contact address: Peter Davey, Population Health Sciences, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, Scotland, DD2 4BF, UK. [email protected]. Editorial group: Cochrane Effective Practice and Organisation of Care Group. Publication status and date: New search for studies and content updated (conclusions changed), published in Issue 2, 2017. Review content assessed as up-to-date: 19 January 2015. Citation: Davey P,Marwick CA, Scott CL, Charani E, McNeil K, Brown E,