Prescription of ceftriaxone before and after implementation of physi-cian's guidelines in a teaching hospital: a brief report

Judicious use of antibiotics is essential considering the growth of antimi-crobial resistance and escalating costs in health care. Ceftriaxone is a third-generation cephalosporin used widely for the treatment of various infections in outpatient and in-patient. The purpose of this study was to evaluate the ceftriaxone utilization before and after implementation of guidelines and physicians education. A descriptive cross-sectional، before-after intervention study was performed in 6 wards of a teaching hospital in Tehran، Iran. The study was conducted in three phases: pre-guideline، educational interventions and post guideline implementation. The pre intervention phase included chart analysis of current ceftriaxone use in 200 consecutive patients from the representative wards included in the study. The educational interventions included preparation and distribution of ceftriaxone guidelines as pamphlets among physicians working in the studied wards. Also the clinical pharmacist returned to each ward and trained physicians regarding the correct use of ceftriaxone. In the post intervention phase immediately after the instruction، and in the follow up phase، one month later، a prospective analysis of ceftriaxone utilization was performed by chart review of 200 patients to detect changes in ceftriaxone utilization pattern. Four hundred cases were evaluated during study (200 before and 200 after physician’s education). The correct indication of ceftriaxone was 93% and 96% before and after the educational interventions respectively. Analysis showed that correct indi-cation of ceftriaxone did not change significantly before and after education (P= 0. 188). Regarding to proper administration (dose، interval and duration) ceftriaxone utilization significantly changed after education (P< 0. 001). Adoption of the guidelines with associated training resulted in significant improvement in ceftriaxone administration pattern in the hospitals.