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Efficacy of educational intervention on reducing the inappropriate use of oral third-generation cephalosporins

  • Atsushi Uda
  • Takeshi KimuraEmail author
  • Sho Nishimura
  • Kei Ebisawa
  • Goh Ohji
  • Mari Kusuki
  • Mariko Yahata
  • Rie Izuta
  • Tomoyuki Sakaue
  • Tatsuya Nakamura
  • Chihiro Koike
  • Issei Tokimatsu
  • Ikuko Yano
  • Kentaro Iwata
  • Takayuki Miyara
Original Paper



This study aimed to evaluate the efficacy of an educational intervention on reducing the inappropriate use of oral third-generation cephalosporins, the prevalence of resistant bacteria, and clinical outcomes.


A before-after study was conducted to compare the data for 1 year before and after intervention at a Japanese university hospital. Educational intervention included lectures for all medical staff on oral antibiotics and educational meetings with each medical department. The primary outcome was the use of oral third-generation cephalosporins in inpatients as measured by the monthly median days of therapy (DOTs) per 1000 patient days. Secondary outcomes included the use of each oral antibiotic in inpatients and outpatients, proportion of β-lactamase-nonproducing ampicillin-resistant Haemophilus influenzae (BLNAR), penicillin-resistant Streptococcus pneumoniae (PRSP) and extended-spectrum β-lactamase producing Escherichia coli (ESBLEC), the incidence of hospital-acquired Clostridioides difficile infection (HA-CDI), and hospital mortality.


The use of oral third-generation cephalosporins in inpatients was significantly decreased after intervention [DOTs (interquartile range): 24.2 (23.5–25.1) vs. 3.7 (0.0–7.1), P < 0.001], and the value in outpatients was also decreased significantly. The use of fluoroquinolones and macrolides did not increase after intervention. The proportion of BLNAR, PRSP and ESBLEC did not change significantly during the study period. The incidence of HA-CDI was significantly decreased, and hospital mortality did not change after intervention.


Educational intervention was effective in reducing the use of oral third-generation cephalosporins without increasing the use of broad-spectrum antibiotics and worsening clinical outcome. The prevalence of resistant bacteria did not change during the study period.


Educational intervention Oral third-generation cephalosporins Antibiotic stewardship Haemophilus influenzae Streptococcus pneumoniae 


Compliance with ethical standards

Conflict of interest

T. Miyara has received grant support from Shionogi & Co., Ltd. The other authors reported no conflicts of interest relevant to this article.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Atsushi Uda
    • 1
    • 2
  • Takeshi Kimura
    • 2
    Email author
  • Sho Nishimura
    • 1
    • 3
  • Kei Ebisawa
    • 1
    • 3
  • Goh Ohji
    • 1
    • 3
  • Mari Kusuki
    • 1
    • 4
  • Mariko Yahata
    • 1
    • 5
  • Rie Izuta
    • 1
    • 5
  • Tomoyuki Sakaue
    • 2
  • Tatsuya Nakamura
    • 6
  • Chihiro Koike
    • 1
  • Issei Tokimatsu
    • 7
  • Ikuko Yano
    • 2
  • Kentaro Iwata
    • 3
  • Takayuki Miyara
    • 1
  1. 1.Department of Infection Control and PreventionKobe University HospitalKobeJapan
  2. 2.Department of PharmacyKobe University HospitalKobeJapan
  3. 3.Department of Infectious DiseaseKobe University HospitalKobeJapan
  4. 4.Department of Clinical LaboratoryKobe University HospitalKobeJapan
  5. 5.Department of NursingKobe University HospitalKobeJapan
  6. 6.Department of Medical Technology and Sciences, Faculty of Health SciencesKyoto Tachibana UniversityKyotoJapan
  7. 7.Division of Clinical Infectious Diseases, Department of Medicine, School of MedicineShowa UniversityTokyoJapan

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