Stewardship with effect – The 4 C’s

This graph depicts the change in percentage of antibiotics belonging to the 4C group – clindamycin, cephalosporins, co-amoxiclav, and ciprofloxacin (fluoroquinolones) in Grampian, Scotland NHS acute care hospitals. There is a strong association with reductions in C. difficile incidence.

This graph show the changes in the individual classes of 4 C’s. Very impressive reductions demonstrating the power of organized stewardship efforts.

Thanks to Dr. Ian Gould for sharing this. This project was specifically designed to reduce the incidence of C. difficile by reducing the use of antibiotics most associated with C. difficile disease. Read more about The 4 C’s Project here at the International Society for Chemotherapy’s World Inventory of Antimicrobial Stewardship site.

It appears that Scotland is making great strides in organized antimicrobial stewardship having established a country-wide multidisciplinary forum in 2008 referred to as the Scottish Antimicrobial Prescribing Group (SAPG). Read more about their efforts here at the SAPG website.