The consequences of inappropriate antibiotic use include increases in antibiotic
resistance, heath-care costs, and antibiotic-related adverse
events. Increasing antibiotic resistance among common pathogenic bacteria
is a world-wide phenomenon that has been recognized as an emerging
threat to public health.
Prescribing guidelines are intended to reduce the inappropriate use of
antibiotics. Our group has implemented the MOXXI electronic prescribing
and drug management system to support community-based prescribing in
Montreal. Analysis of data from this system revealed poor adherence to
antibiotic prescribing guidelines for major categories of infections.
Guidelines are based on national data of the prevalence of different pathogens
and their sensitivity to antimicrobials. As a result, guidelines
give recommendations for empirical antibiotic treatment that are general
and not tailored to local prevalence patterns. Seasonal, temporal, and
location-related variation in the bacterial causes of infections, and
antimicrobial resistance are not incorporated into guideline recommendations. When
physicians prescribe antibiotics to treat an infection, the
resulting uncertainty as to the pathogen and its resistance
drives them to prescribe antibiotics with a broader spectrum than needed. Reducing
this uncertainty at the time of prescribing is likely to
reduce inappropriate use of antibiotics.
A computerized decision support system for empirical antibiotic prescribing
that incorporates the likely infectious organism, antibiotic susceptibility, and
patient characteristics to provide guideline-based treatment
recommendations at the point of care, should decrease inappropriate
Such a system was successfully implemented in a hospital setting, but not
in a community setting.