The effectiveness of prescription support and treatment reporting system on the appropriate usage of oral third-generation cephalosporins

Preauthorization and prospective audit and feedback system are reported to be effective for the achievement of appropriate use of intravenous antimicrobials, but few reports on oral antimicrobials are available, especially for adults. The prescription of oral third-generation cephalosporins (oral 3rd Ceph) for inpatients and outpatients from 2013 to 2018 was investigated. The study period was divided into three phases. First, prescription support to suggest discontinuation of antimicrobials for unnecessary prescriptions, and alternative antimicrobials for inappropriate prescriptions were provided. Next, we continued prescription monitoring, and observed the trends of antimicrobial prescription without support. Finally, we have introduced prescription reporting system to promote the appropriate use of oral 3rd Ceph. In each phase, we evaluated days of therapy per 1000 patient-days and prescriptions per 1000 visits as an index of effectiveness of our interventions. The total annual amount of oral 3rd Ceph usage decreased significantly over time between phases, respectively. During the same period, the incidence rate of methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum β-lactamase (ESBL)-producing bacteria, and AmpC β-lactamase (AmpC)-producing bacteria was not changed significantly, indicating that oral 3rd Ceph usage was reduced without a concomitant increase of the drug-resistant bacteria. Simultaneously, the annual usage of other broad-spectrum antimicrobial agents such as oral fluoroquinolones and oral macrolides also decreased, which indicated these antimicrobials were not prescribed as an alternative for oral 3rd Ceph. The combination of prescription support activity and treatment reporting system for oral antimicrobial agents is an effective method for promoting appropriate oral antimicrobial use.