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Clinical decision system helps reduce inappropriate antimicrobial prescribing

A clinical decision support system intervention reduced the overall use of antimicrobials for respiratory tract infections such as colds, bronchitis and sinusitis, according to a study in the November 9 issue of JAMA.

Antimicrobial resistance is a serious public threat that is exacerbated by the gradual withdrawal of the pharmaceutical industry from new antimicrobial agent development, according to background information in the article. Overuse of antimicrobial agents fosters the spread of antimicrobial-resistant organisms. Despite recent trends that demonstrate reduced outpatient use of antimicrobial agents, prescribing continues to significantly exceed prudent levels. Approximately 50 percent of courses of ambulatory antimicrobial drugs are prescribed for patients with viral respiratory infections and therefore, are not clinically indicated.

Matthew H. Samore, M.D., of the University of Utah, Salt Lake City, and colleagues evaluated the effectiveness of a direct intervention with primary care clinicians that was used to reduce the rate of inappropriate prescribing of antimicrobial drugs for acute respiratory infections. The intervention, the clinical decision support system (CDSS), incorporated stand-alone decision support tools on paper and a handheld personal digital assistant (PDA) to guide diagnosis and management of the acute respiratory tract infection. The researchers measured the added value of the CDSS when coupled with a community intervention.

The PDA-based CDSS generated diagnostic and therapeutic recommendations on the basis of patient-specific information that was input about the suspected diagnosis, such as the presence or absence of specific symptoms and signs. Therapeutic recommendations included over-the-counter medications for symptom control as well as prescription antimicrobials. In the study, antimicrobial agents were grouped into 4 classes: penicillins, macrolides, cephalosporins, and other.

The randomized tri
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Contact: Chantelle Turner
801-581-5717
JAMA and Archives Journals
8-Nov-2005


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