Objectives To determine the incidence of hospital admissions for adverse events related to drug therapy, and to assess whether these drug‐related admissions (DRAs) could have been reasonably prevented. Setting A tertiary teaching hospital. Design and patients Prospective assessment of all admissions through the emergency department and resulting in a stay of more than 24 hours during 30 consecutive days in November and December 1994 to determine if the admission was related to drug therapy. Cases of intentional overdose were excluded. Main outcome measures The number, type, causality and avoidability of drug‐related admissions. Results Of 965 admissions, 55 (5.7%) were assessed as being drug‐related. Drug‐related admissions (DRAs) were designated possibly (38%), probably (46%) or definitely (16%) drug‐related; caused by prescribing factors (26%), patient noncompliance (27%) and adverse drug reactions (47%); and classified as definitely (5.5%), possibly (60.0%) and not (34.5%) avoidable. The estimated annual cost to the hospital for all DRAs was $3496956 and for unavoidable DRAs was $1629494. Conclusion The DRA rate we found lies around the middle of the range of other published rates. Few DRAs were judged definitely avoidable and over one‐third were unavoidable. Nevertheless, the largest proportion were judged possibly avoidable. As the drugs identified in this study are clearly needed in the community, efforts to reduce DRAs must concentrate on education, counselling and monitoring of drug therapy.

Summary   In Australia, the antibiotic resistance crisis may be partly alleviated by reducing antibiotic use in general practice, which has relatively high prescribing rates — antibiotics are mostly prescribed for acute respiratory infections, for which they provide only minor benefits. Current surveillance is inadequate for monitoring community antibiotic resistance rates, prescribing rates by indication, and serious complications of acute respiratory infections (which antibiotic use earlier in the infection may have averted), making target setting difficult. Categories of interventions that may support general practitioners to reduce prescribing antibiotics are: regulatory (eg, changing the default to “no repeats” in electronic prescribing, changing the packaging of antibiotics to facilitate tailored amounts of antibiotics for the right indication and restricting access to prescribing selected antibiotics to conserve them), externally administered (eg, academic detailing and audit and feedback on total antibiotic use for individual GPs), interventions that GPs can individually implement (eg, delayed prescribing, shared decision making, public declarations in the practice about conserving antibiotics, and self‐administered audit), supporting GPs' access to near‐patient diagnostic testing, and public awareness campaigns. Many unanswered clinical research questions remain, including research into optimal implementation methods. Reducing antibiotic use in Australian general practice will require a range of approaches (with various intervention categories), a sustained effort over many years and a commitment of appropriate resources and support.

Objective: To determine patterns of use of ceftriaxone and cefotaxime (CEFX) in Victorian hospitals and to identify areas for improvement. Design, patients and setting: A concurrent, observational evaluation of CEFX use in patients commencing a course of these drugs between 8 and 14 September, 1999, in 51 Victorian hospitals. Main outcome measures: Proportion of patients treated with CEFX; indications; duration of use; concordance with recommendations of national antibiotic guidelines (Therapeutic guidelines: antibiotic, 10th edition [AG10]). Results: 671 patients were treated with CEFX. The overall rate of use was 43 patients per 1000 inpatient separations. Treatment of respiratory tract infection accounted for 352 patients (52%) and surgical prophylaxis for 99 patients (15%). Treatment of skin/soft tissue, urinary tract and gastrointestinal tract infections accounted for about 7% of patients each. The median duration of CEFX courses was 3.0 days. The overall rate of concordance with indications recommended in AG10 was 27%. The rate of concordance for empirical treatment of respiratory tract infection was 24%. Of the 195 patients treated empirically with CEFX for community‐acquired respiratory tract infection and assessed as non‐concordant, 64% did not have radiological evidence of pneumonia, and a further 30% did not fulfill the criteria for severe pneumonia. All courses given for surgical prophylaxis were non‐concordant. Conclusions: CEFX is widely used in Victorian hospitals, mostly to treat lower respiratory tract infection and in surgical prophylaxis of infection. The rate of concordance with AG10 is low. Potential areas for intervention include empirical treatment of respiratory tract infection and use in surgical prophylaxis.

Objective: To achieve sustained improvement in use of cefotaxime and ceftriaxone (CEFX) in a major teaching hospital, as measured against national antibiotic guidelines. Design and setting:Pre-and post-intervention survey of CEFX use in the Royal Melbourne Hospital, a tertiary hospital in Melbourne, Victoria.Intervention: Web-based antimicrobial approval system linked to national antibiotic guidelines was developed by a multidisciplinary team and implemented in March 2001. Main outcome measures: Change in rate of CEFX use (defined daily doses [DDDs]per 1000 acute occupied bed days) over 8 months pre-and 15 months postintervention; concordance of indication for CEFX with national antibiotic guidelines pre-and post-intervention.Results: CEFX use decreased from a mean of 38.3 DDDs/1000 bed days preintervention to 15.9, 18.7 and 21.2 DDDs/1000 bed days at 1, 4 and 15 months postintervention. Concordance with national antibiotic guidelines rose from 25% of courses pre-intervention to 51% within 5 months post-intervention (P < 0.002). Gentamicin use also increased, from a mean of 30.0 to 48.3 DDDs/1000 bed days (P = 0.0001). Conclusion:The web-based antimicrobial approval system achieved a sustained reduction in CEFX use over 15 months as well as increased prescribing concordance with antibiotic guidelines. It has potential for linking to electronic prescribing and for wider MJA 2003; 178: 386-390 use for other drugs, as well as for research into the epidemiology of antibiotic use.

EducationIdeally medical students should be educated in the principles of good prescribing before they enter the hospital. On the wards, these principles should be reinforced with bedside teaching and examinations. The quality use of medicines needs to be recognised as an important part of medical education and intern training programs.Junior medical staff make most of the prescribing decisions in hospitals and young interns prescribe largely by following the instructions of more senior residents and consultants. Educational activities should be tailored to the different levels of therapeutic decision-making in teaching hospitals.While they may be useful to disseminate information, didactic educational meetings such as lectures, alone, have little or no effect on practice. 7 The impact of training and education seems to be increased by:• using interactive meetings (e.g. group problem solving, role playing, workshops)• repeated sessions