Implementing Practice Guidelines for Appropriate Antimicrobial Usage

BACKGROUND: Antimicrobial resistance is increasing, apparently in part as a result of the inappropriate use of antimicrobial agents. OBJECTIVES: To conduct a systematic review of guideline implementation studies for improving appropriate use of antimicrobial agents and to determine which implementation methods appear to improve the outcome of appropriate antimicrobial use. RESEARCH DESIGN: The Medline database was searched for comparative studies on guideline implementation of appropriate antimicrobial use in common infections. Estimates of treatment effects and costs were included. The community-acquired infections selected were otitis media, respiratory illnesses, pharyngitis, and sinusitis. The nosocomial infections selected were urinary tract infections and surgical wound infections. Antiretroviral treatment studies and vancomycin usage studies were also included. Other computer-assisted antibiotic control studies not selected in the above topics were included. RESULTS: Forty studies were found that documented the effectiveness of implementation methods in encouraging appropriate antimicrobial use. The available evidence showed that multifaceted implementation methods were most successful. Individual implementation methods that appeared to be useful were academic detailing, feedback from nurses, pharmacists, or physicians, local adaptation of a guideline, small-group interactive sessions, and computer-assisted care.