摘要：Third generation cephalosporin antibiotics (3GC) have become the antibiotics of choice in manyhospitals in recent years for the treatment of infections such as community-acquired pneumonia.However, increased use of 3GCs has also been associated with a rise in the occurrence of antibiotic-associated diarrhoea due to Clostridium difficile, as well as an increase in the prevalence of antibioticresistant organisms such as methicillin resistant Staphylococcus aureus, vancomycin resistantentrococci, and extended-spectrum beta-lactamase–producing gram negative bacilli. In WesternAustralia, greater use of 3GCs was shown to correlate with more Clostridium difficile–associateddiarrhoea (CDAD) in a large acute care teaching hospital during the 1980s. During the 1990s, the useof 3GCs in this hospital remained high and, at the end of 1998, a policy was introduced to prevent theuse of ceftriaxone (the only 3GC in use) without prior approval. This resulted in a decline in 3GC useand a 50 per cent reduction in the incidence of CDAD during 1999 and 2000. To strengthen theseobservations, the impact of the 3GC policy on the occurrence of CDAD was analysed using time-seriesintervention analysis that showed a statistically significant decrease in the occurrence of CDAD duringthe post-intervention period after controlling for exogenous factors. Thus, changes in antibioticprescribing practices can influence the incidence of CDAD and, potentially, antibiotic resistantpathogens
