Midtveisevaluering - Jannicke Slettli Wathne
Prudent use of antibiotics in hospitals – bridging the evidence gap for implementing antibiotic stewardship interventions in Norwegian hospitals
The introduction of antibiotics has dramatically altered the prognosis of patients with bacterial infections. However, decades of overuse and misuse have accelerated the development of resistant bacteria and broad-spectrum drugs are especially prone to drive resistance. Antibiotics constitute the only class of medicines where the use of a particular substance has implications beyond the patient receiving the drug today. Clinical guidelines for antibiotic use are developed for efficient and safe treatment of the patient of today, while also considering ecology and minimize development of antibiotic resistance. Responsible prescribing in accordance with clinical practice guidelines is vital to conserve efficient antibiotics. Norway is at the starting point of implementing antibiotic stewardship programs in hospitals, where a key element is to identify challenges related to antibiotic use and addressing them through implementing effective interventions that promote prudent prescribing. In the first study we use a cluster randomized controlled design to investigate two proposed antibiotic stewardship interventions, both their applicability and effectiveness, but also possible additional effects of tailored implementation in a Norwegian setting.
The best clinical outcome for the patient is the basis of all decisions made by healthcare personnel, and trust in clinical guidelines is therefore crucial. Studying the effect of antibiotic use on patient outcome is of great importance to make sure that guideline-adherent prescribing practice is safe and secures equal – or better patient outcome. The second study will therefore focus on how prescribing practice is affecting our patients.
In the third study we aim to thoroughly understand the current antibiotic prescribing practice, looking at the whole process of antibiotic prescribing in hospitals, examining the changes made, when they occur and what factors are affecting this process. If we can understand when and where important changes are made and the predictors of change, we increase the likelihood of succeeding in the implementation of antibiotic stewardship interventions, both in Norway and internationally.