Trial at Hong Kong hospital reduces needless issue of strong antibiotics

A pilot scheme greatly reduced the volume of stronger medicine being prescribed, helping in the fight to contain drug-resistant 'superbugs'

PUBLISHED : Monday, 24 September, 2012, 12:00am
UPDATED : Monday, 24 September, 2012, 4:05am

An award-winning pilot project at a public hospital has reduced the "unnecessary" use of powerful "big-gun" antibiotics, a measure that is seen as vital to containing the threat of drug-resistant superbugs.

In the first two months of the trial scheme at Princess Margaret Hospital's medicine and geriatrics department, 54 per cent of strong antibiotics dished out were found to be unnecessary. By the final two months, that figure was down to 11 per cent.

The consumption of big-gun antibiotics at the department between 2010 and last year was reduced by half when compared to the year before, with the annual bill for the drugs falling from HK$4 million to HK$2.7 million.

"Unnecessary use" doesn't mean the drug could not help the patient, explained Dr Joseph Tsang Kay-yan, an associate consultant of the Kwai Chung hospital's infectious disease centre who led the project. "But assessment afterwards may find that it didn't require such a strong antibiotic."

While the trial did offer financial savings, there was a cost in doctors' time, with medics having to call an infectious disease specialist and discuss the patient's case before prescribing strong antibiotics.

Previously, doctors would fill in a form and send it to pharmacists and infectious disease specialists for assessment after the drugs had been administered.

"It led to a change in culture and behaviour in antibiotics prescription," said Tsang.

Doctors usually turn to stronger antibiotics when first-line antibiotics do not work. Discussing the case with specialists in infectious disease helps doctors take into account more factors regarding the patient's past and present condition.

Reducing the use of antibiotics was identified as an important part of the battle to contain drug-resistant "superbugs" because more frequent use of antibiotics means bacteria have more chance to develop resistance, leaving medics with no defence against them. Bugs such as MRSA (methicillin-resistant Staphylococcus aureus) have grown more common in the city and elsewhere in recent years.

Though the trial scheme was for one year, the practices introduced have continued. Tsang said he hoped it could expand to more departments.

The hospital's project won an "excellence award" at the Hospital Management Asia conference this month.

Infectious disease specialist, Dr Jacky Chan Man-chun, said it was not easy when the scheme first started.

His discussions with doctors seeking to prescribe antibiotics ranged from phone calls lasting several minutes to visiting the patients in complicated cases.

"Sometimes we were stopping doctors from prescribing the antibiotic," Chan said.

The medicine and geriatrics department's chief of service, Dr Matthew Tong Kwok-lung, said doctors found that exchanging ideas with infectious disease specialists to be a good learning experience.