Summary: We examined the impact of a rational antibiotic prescription programme based on a multi- disciplinary consultative approach in a 600-bed hospital. The programme involved four measures: (1) drawing up of a local prescribing consensus with all prescribers; (2) a restricted prescriptions policy for the most expensive antibiotics; (3) assessment of the prescription of these antibiotics by regular audits; and (4) institutional training and information for prescribers. The impact of the programme was assessed by comparing actual prescriptions with the criteria of the local consensus, compliance with the restrictive prescription policy, changes in the average daily cost of antibiotic therapy per inpatient and changes in the local ecology of methicillin-resistant Staphylococcus aureus (MRSA), Enterobacteriaceae producing extended-spectrum B-lactamases (EPESB) and ceftazidime-resistant Pseudomonas species (CRP). Using a participatory consensual approach, 182 reference recommendations were established (104 for adults, 78 for children), corresponding to 85% of the clinical settings encountered in the hospital. Six audits, conducted since June 1997, show that the rate of unjustified prescriptions first fell significantly (from 6 to 0%, P < 0.001), then increased significantly (from 0 to 3%, P < 0.05) before stabilizing at 3%. The cost of antimicrobials per inpatient day fell significantly (from US$ 13.8 in 1997 to US$ 11 in 2000, P < 0.001). The prevalence of MRSA and CRP remained stable, while that of EPESB fell significantly (P < 0.001). This multidisciplinary consultative approach thus reduced antibiotic costs, contributed to infection control, and improved the quality of antibiotic prescription.

• Quantitative data - Quantitative data were used during the intervention
• Qualitative data - Qualitative data were used during the intervention

• Human - All activities regarding organisations and individuals involved in health products and services

• Healthcare delivery