Concordance with antibiotic guidelines in Australian primary care: A retrospective study of prior‐to‐hospital therapy

Caitlan O'Keefe, Angus Thompson, Duncan McKenzie, Kenneth Lee

Research output: Contribution to journalArticle

Abstract

1 Background
Appropriate antibiotic prescribing improves patient outcomes and mitigates antimicrobial resistance. As the majority of antibiotics are used in the community, rational prescribing in this setting is of paramount importance.

2 Objectives
We aimed to (1) evaluate the concordance of community antibiotic prescribing with guidelines for three common infection types among patients who presented to hospital, and (2) identify relationships between guideline concordance and patient‐related factors.

3 Methods
Medical records were evaluated from the Royal Hobart Hospital (Tasmania, Australia) for patients presenting with respiratory tract, urinary tract or skin and soft tissue infections within a 12‐month period. Prior‐to‐hospital antibiotic therapy was assessed for concordance with prescribing guidelines based on presenting diagnosis. Concordance was assessed against first‐line recommendations in the Australian Therapeutic Guidelines ‐ Antibiotic, based on drug choice, dose, frequency and patient factors. Descriptive statistics were performed to address Objective 1. Multivariate logistic regressions were conducted to address Objective 2 with the following independent variables: infection type, age, allergies, diabetes status, gender and residential setting.

4 Results
A total of 285 patient records were eligible for data analysis; 28.8% (n = 82) were fully guideline concordant. The most common reason for non‐concordance was inappropriate drug choice (n = 143, 50.2%). Patients with the following characteristics were less likely to receive concordant therapy: diabetes (OR = 0.3, 95% CI 0.1‐0.8, P = .02) and increasing age (OR = 0.99, 95% CI 0.98‐1.00, P = .04).

5 Conclusions
Almost three‐quarters of patients received community‐initiated antibiotic therapy that was not fully guideline concordant. Antimicrobial stewardship interventions are urgently needed to improve guideline concordance for community‐initiated antibiotic therapy.
Original languageEnglish
Pages (from-to)e13427
JournalInternational Journal of Clinical Practice
DOIs
Publication statusPublished - Oct 2019

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