Objective: To determine whether removal of default duration, embedded in electronic prescription (e-script), influenced antibiotic days of therapy. Design: Interrupted time-series analysis. Setting: The study was conducted across 2 community hospitals, 1 academic hospital, 3 emergency departments, and 86 ambulatory clinics. Patients: Adults prescribed a fluoroquinolone with a duration <31 days. Interventions: Removal of standard 10-day fluoroquinolone default duration and addition of literature-based duration guidance in the order entry on December 19, 2017. The study period included data for 12 months before and after the intervention. Results: The study included 35,609 fluoroquinolone e-scripts from the preintervention period and 31,303 fluoroquinolone e-scripts from the postintervention period, accounting for 520,388 cumulative fluoroquinolone DOT. Mean durations before and after the intervention were 7.8 (SD, 4.3) and 7.7 (SD, 4.5), a nonsignificant change. E-scripts with a 10-day duration decreased prior to and after the default removal. The inpatient setting showed a significant 8% drop in 10-day e-scripts after default removal and a reduced median duration by 1 day; 10-day scripts declined nonsignificantly in ED and ambulatory settings. In the ambulatory settings, both 7- and 14-day e-script durations increased after default removal. Conclusion: Removal of default 10-day antibiotic durations did not affect overall mean duration but did shift patterns in prescribing, depending on practice setting. Stewardship interventions must be studied in the context of practice setting. Ambulatory stewardship efforts separate from inpatient programs are needed because interventions cannot be assumed to have similar effects.

中文翻译：

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违约是魔鬼：对违约持续时间消除对氟喹诺酮治疗暴露影响的间断时间序列分析

目的：确定电子处方（e-script）中嵌入的默认持续时间的删除是否影响抗生素治疗天数。设计：中断时间序列分析。背景：该研究在 2 家社区医院、1 家学术医院、3 个急诊科和 86 个门诊诊所进行。患者：成人服用氟喹诺酮类药物，疗程<31天。干预措施：取消标准的 10 天氟喹诺酮默认持续时间，并在 2017 年 12 月 19 日的订单条目中添加基于文献的持续时间指导。研究期间包括干预前后 12 个月的数据。结果：该研究纳入了干预前的 35,609 个氟喹诺酮类电子脚本和干预后的 31,303 个氟喹诺酮类电子脚本，总计 520,388 个氟喹诺酮类 DOT。干预前后的平均持续时间分别为 7.8 (SD, 4.3) 和 7.7 (SD, 4.5)，变化不显着。在默认删除之前和之后，持续时间为 10 天的电子脚本有所减少。住院环境显示，默认删除后 10 天的电子脚本显着下降了 8%，中位持续时间减少了 1 天；在急诊室和门诊环境中，10 天脚本略有下降。在门诊设置中，默认删除后 7 天和 14 天的电子脚本持续时间都增加了。结论：取消默认的 10 天抗生素持续时间不会影响总体平均持续时间，但会改变处方模式，具体取决于实践环境。管理干预措施必须在实践背景下进行研究。需要将流动管理工作与住院计划分开，因为不能假设干预措施具有类似的效果。