Effectiveness of Implementing a Locally Developed Antibiotic Use Guideline for Community-Acquired Cellulitis at a Large Tertiary Care University Hospital in Thailand

BACKGROUND: To determine the effectiveness of implementing a locally developed clinical practice guideline (CPG) for antibiotic treatment in adults with community-acquired cellulitis at Siriraj Hospital in Bangkok, Thailand. METHODS: The CPG for antibiotic treatment of community-acquired cellulitis was developed based on local data during June to December 2016. The CPG was introduced by multifaceted interventions, including posters, brochures, circular letters, social media, conference, classroom training, and interactive education during January to September 2018. RESULTS: Among 360 patients with community-acquired cellulitis, 84.4% were ambulatory and 15.6% were hospitalized. The median age of patients was 62 years, and 59.4% were female. Antibiotic prescription according to CPG (CPG-compliant group) was observed in 251 patients (69.7%), and CPG noncompliance was found in 109 patients (30.3%) (CPG-noncompliant group). The demographics and characteristics of patients were comparable between groups. Patients in the CPG-compliant group had a significantly lower rate of intravenous antibiotics (18.7% vs 33.9%, P = .007), lower prescription rate of broad-spectrum antibiotics (14.7% vs 78.9%, P < .001) and antibiotic combination (6.4% vs 13.8%, P = .022), shorter median duration of antibiotic treatment (7 vs 10 days, P < .001), lower median cost of antibiotic treatment (US $3 vs $7, P < .001), and lower median hospitalization cost (US $601 vs $1587, P = .008) than those in the CPG-noncompliant group. Treatment outcomes were not significantly different between groups. CONCLUSIONS: Adherence to CPG seems to reduce inappropriate prescription of broad-spectrum antibiotic or antibiotic combination and treatment costs in adults with community-acquired cellulitis without differences in favorable outcomes or adverse events.