The mass use of antibiotics has caused a rise of bacterial resistance to these drugs that is threatening to destroy the power of these life saving drugs.
Two separate systematic reviews published this week in The Cochrane Library show how appropriate interventions in hospitals and doctors' offices can result in improvements in the ways doctors prescribe antibiotics and may lead to a reduction in resistant bacteria.
A systematic review of 66 different studies showed that improving the way that antibiotics are prescribed in hospital to inpatients can reduce antibiotic resistance and hospital acquired infection.
The Cochrane Review Authors divided interventions into those that sought to educate or persuade staff to change their prescribing behaviour, and those that imposed a restrictive set of guidelines or orders. An example of this is that some interventions restricted the range of antibiotics that physicians in the hospital could prescribe, while other persuasive interventions got hospital pharmacists to recommend alternative antibiotics to those initially requested.
Other examples of frequently used persuasive techniques were various forms of lectures, seminars and case reviews with all grades of medical and nursing staff.
The authors found that restrictive interventions had a greater immediate impact than persuasive interventions. "But hospitals should resist the temptation to adopt restrictive interventions without evaluating their long-term effects, particularly on clinical outcomes," says lead author Peter Davey who works at Ninewells Hospital and Medical School, Dundee.
"Interestingly, we found that interventions are less likely to be successful if there is evidence that practice is already changing in the desired direction," says Davey.
A systematic review of 39 studies showed that attitudes towards prescribing were most powerfully changed if the intervention aimed to take account of local situations at the same time as educating prescribing physicians and patients. Indeed more complex interventions including one-on-one meetings with physicians, small group discussions or combinations of approaches were more likely to have an effect on reducing the misuse of antibiotics.