Impact of a training session for prescribers on the relative prescription of cefotaxime over ceftriaxone in elderly patients.

BACKGROUND: The prescription of ceftriaxone should be limited to patients with biliary tract infections and those lacking intravenous access. A specific training session for prescribers about the clinical relevance and economic value of prescribing cefotaxime instead of ceftriaxone might decrease the use of the latter in geriatric medicine. OBJECTIVES: To determine the clinical and economic impact of a training session for prescribers on the subsequent prescription of third-generation cephalosporin, that is, the percentage of appropriate prescriptions and the cost of third-generation cephalosporin administration before and after the training session. METHODS: In a preliminary observational quasi-experimental, open-label study, appropriateness of cefotaxime and ceftriaxone prescription over a 4-week period immediately before the training session were compared with those during a 4-week period immediately afterwards. KEY FINDINGS: For 46 patients (29 before the training session and 17 afterwards), the proportion of cefotaxime prescriptions increased (from 3% to 35%; P = 0.007), and the proportion of appropriate prescriptions increased at the start of treatment (from 45% to 76%; P = 0.064) and at the end (from 76% to 88%; P = 0.450). The daily per-patient cost of treatment was €8 for cefotaxime and from €1.63 to €3.42 for ceftriaxone, depending on the administration route. CONCLUSIONS: A training session for prescribers was associated with a decrease in ceftriaxone prescriptions encouraging further studies to improve the training session and then evaluate medico-economic impact through randomized clinical trials.