"The challenge has been knowing how these programs can be implemented in small hospitals, where, historically, they've been absent, even though antibiotic use rates in small hospitals are very similar to large hospitals, where the programs are typically found," he added.

While many smaller hospitals have lacked the resources to build a formal antibiotic stewardship program, researchers determined that using a centralized infectious disease support program decreased overall antibiotic use and the overuse of most broad-spectrum drugs, which are used to target a wide range of bacteria that cause diseases.


Prior to the study, each of the participating hospitals lacked antibiotic stewardship programs. Each hospital was randomly assigned to one of three types of programs to determine which was most effective in reducing broad-spectrum antibiotic use:

Program 1:

Implemented basic education to physicians and staff on antibiotic stewardship programs
Provided a 24/7 infectious disease hotline staffed by infectious disease specialists
Program 2:

Provided more advanced antibiotic stewardship education
Provided a 24/7 infectious disease hotline staffed by infectious disease specialists
Implemented a pharmacy-based initiative in which local pharmacists reviewed use of broad-spectrum antibiotics and provided recommendations for improvement to prescribers
Certain broad-spectrum antibiotics were restricted and only local pharmacy staff could approve their use
Program 3:

Provided more advanced antibiotic stewardship education
Provided a 24/7 infectious disease hotline staffed by infectious disease specialists
Implemented a pharmacy-based initiative in which local pharmacists reviewed most antibiotic prescriptions and provided recommendations for improvement to prescribers
Certain broad-spectrum antibiotics were restricted and only centralized infectious diseases pharmacists could approve their use
Infectious disease specialists reviewed selected microbiology results and spoke with local providers about recommendations for treatment
"For the first time, all of the participating hospitals had access to infectious diseases physicians via a hotline," said Dr. Stenehjem. "This allowed the patients to receive expert consultation while remaining in their community."

Only hospitals in program 3 saw a significant reduction in antibiotic use compared to baseline data. Hospitals in program 3 reduced broad-spectrum antibiotic use by 24 percent and total antibiotic use by 11 percent.

"The bottom line is, small hospitals cannot do it by themselves, but by sharing experts and resources within a system, they can really reduce the inappropriate use of antibiotics," said Andrew Pavia, MD, professor of pediatrics at University of Utah Health. "And more appropriate use of antibiotics will help address the growing problem of 'superbugs' that can cause costly and dangerous infections.'"

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