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Daniel H. Solomon, MD, MPH; Laura Van Houten, BA; Robert J. Glynn, PhD, ScD; Lindsey Baden, MD; Kelley Curtis, RPh, MBA; Harry Schrager, MD; Jerry Avorn, MD

Arch Intern Med. 2001;161:1897-1902.

Background  Antibiotic misuse is common and costly and may promote antibiotic resistance. We tested the efficacy of a targeted one-on-one educational program ("academic detailing") designed to improve the appropriateness of broad-spectrum antibiotic use.

Methods  A randomized controlled trial was conducted in a large US teaching hospital. During an 18-week study period, 17 general medical, oncology, and cardiology services either received academic detailing or did not. The intervention was prompted by an order for either levofloxacin or ceftazidime that led to a computer-based review of data for that patient. Orders for the 2 target antibiotics deemed unnecessary by a priori criteria were included in the study. The primary outcome examined was the number of days that unnecessary levofloxacin or ceftazidime was administered in intervention and control groups.

Results  Before the trial, intervention and control services had similar prescribing patterns for the target antibiotics; the drugs were used for similar indications throughout the study period. During the intervention, there was a reduction of 37% in days of unnecessary levofloxacin or ceftazidime use per 2-week interval on services randomized to the educational intervention vs control services (P<.001). In multivariable analyses controlling for baseline prescribing and study interval, the rate of unnecessary use of the 2 target antibiotics was reduced by 41% on the intervention services compared with controls (95% confidence interval, 44%-78%; P<.001). Length of stay, intensive care unit transfers, readmission rates, and in-hospital death rates were similar in both groups (P.10 for all).

Conclusion  Targeted one-on-one education is a practical, effective, and safe method for reducing excessive broad-spectrum antibiotic use.

From the Divisions of Pharmacoepidemiology and Pharmacoeconomics (Drs Solomon, Glynn, and Avorn and Mss Van Houten and Curtis) and Infectious Diseases (Drs Baden and Schrager), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

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