Reducing incorrect antibiotic dosing and enhancing prescriber adherence through a real-time, patient-specific...

Incorrect antibiotic dosing remains common, particularly in patients with renal impairment or obesity, contributing to treatment failure and antimicrobial resistance. Although clinical decision support systems (CDSS) are increasingly used, few offer real-time, patient-specific dosing recommendations based on a curated antibiotic dosing database integrated directly into prescribing workflows, limiting the optimization of antimicrobial therapy.

We implemented a mandatory CDSS for restricted antibiotics at a 1100-bed tertiary hospital. The system automatically integrated renal function and body weight from the electronic medical record, along with prescriber-selected dialysis modality, to generate predefined, guideline-based dosing options tailored to individual clinical scenarios. Prescribers were required to either accept a recommended dose or provide justification for overriding it. We retrospectively analysed 81 164 prescriptions after implementation to assess CDSS-adherence and compared 41 550 pre- and 33 994 post-implementation prescriptions to evaluate dosing accuracy.

CDSS-adherence increased from 62.2% to 92.6% during the post-implementation period, while the incorrect antibiotic dosing rate declined from 3.7% to 2.1% (P < 0.001). Among non-adherent prescriptions, 72.4% of manually entered doses were concordant with CDSS recommendations and were associated with a lower incorrect dosing rate than discordant overrides (0.5% vs. 9.7%; P < 0.001). Key system refinements, including support for inhaled colistin and agent-specific loading dose guidance, further improved usability and CDSS-adherence.

By integrating real-time, patient-specific parameters into the prescribing process and offering guideline-aligned recommendations, this CDSS significantly improved prescriber adherence and reduced incorrect antibiotic dosing. The system shows strong potential to improve medication safety and support antimicrobial stewardship.