Active promotion of antibiotic guidelines: an intensive program.

John Hunter Hospital, a 600 bed tertiary referral centre, has an antimicrobial working party comprising representatives from pharmacy, microbiology and infectious diseases areas, which is responsible for the development, implementation and evaluation of guidelines for the appropriate use of antimicrobials. Activities include the development and promotion of a restricted antimicrobial policy, and specific guidelines for the management of pneumonia, and surgical prophylaxis and wound infection. These guidelines are available on the hospital intranet, in hard copies in all wards, and on laminated cards (10 x 6.5 cm) attached to the hospital identification tag. Active promotion of the guidelines is undertaken at orientation and via a 2 week intensive period four times per year (corresponding with the registrar rotation), weekly meetings and follow up of non-compliance courses directly with the attending medical officer. Education and feedback to specific groups is provided as required. Other projects include a campaign to encourage oral antibiotics where indicated. Regular drug utilisation evaluations are undertaken to measure outcomes, along with other indicators of antibiotic use such as the prevalence of antimicrobial resistance. Appropriate prescribing of third generation cephalosporins has increased from 21 per cent to 52 per cent (p = 0.008) of courses between December 1999 and June 2001.