Introduction: The rationalization of medical practices for antibiotic use in hospitals is necessary to improve both the cost-efficiency and effectiveness of health care. This study sought to investigate the impact of implementation of local management guidelines for inpatient community-acquired pneumonia (CAP).
Methods: This retrospective, comparative study measured the quality of antibiotic prescriptions with the 10-item Medication Appropriateness Index (MAI). Clinical and demographic characteristics, as well as process-of-care and outcome indicators, were recorded for all patients with CAP admitted to a medical ward at the Nantes university hospital during two 12-month periods: before (Period A, 39 patients) and after (Period B, 50 patients) implementation of local guidelines.
Results: The MAI was significantly higher during period B than period A (5.1 points compared with 2.2, p=0.0001). Guideline implementation shortened the mean duration of antibiotic treatment (13.1 versus 16.0 days, p=0.0003) and of intravenous treatment (3.4 versus 4.7 days, p=0.04). The mean duration of hospital stay also fell substantially (7.4 versus 15.0 days, p=0.0001), as did the mean cost of antibiotics (35.4 versus 64.1 euros, p=0.003).
Discussion: The MAI confirmed that antimicrobial practices varied significantly and that appropriate local guidelines improved the quality of antibiotic prescriptions and saved hospitalization costs.
Conclusion: The MAI, which assesses the appropriateness of antibiotic use in hospitals, could be an interesting tool for prospective use as an indicator of quality-of-care improvement and for more efficient use of available health care resources.