Evaluation of prescription practices of antibiotics in a medium-sized Swiss hospital

• Published in: Swiss medical weekly Vol. 135; no. 47-48; pp. 710 - 714
• Main Authors: Di Giammarino, Loriana, Bihl, Florian, Bissig, Marco, Bernasconi, Beatrice, Cerny, Andreas, Bernasconi, Enos
• Format: Journal Article
• Language: English
• Published: Switzerland 10-12-2005
• Subjects: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - economics; Bacterial Infections - drug therapy; Cost-Benefit Analysis; Drug Costs; Drug Utilization Review; Female; Guideline Adherence; Hospitals; Humans; Infusions, Intravenous; Male; Middle Aged; Practice Patterns, Physicians; Prospective Studies; Switzerland; Switzerland
• ISSN: 1424-7860

The use of guidelines standardises prescription practices for antibiotics against the most common infectious diseases (ID) and favours an early switch from intravenous (IV), to oral (PO) therapy. The goals of this observational study were to evaluate adherence to guidelines and streamlining of antibiotics.
Hospitalised patients, diagnosed with a possible ID and receiving antibiotics (ABs) for at least five days were included. Data for all patients receiving ABs in the Intensive Care Unit, medical and surgical ward were collected. The collected information was reviewed for indication of AB prescription. Patient's data were assigned into one of eight groups based on the ID diagnosis.
Over a period of six months, 129 patients from three hospital wards were included; 124 patients with a confirmed ID diagnosis were considered for further analysis. The four most frequent diagnoses were: community acquired pneumonia, urinary tract infection, skin and soft tissue infection, and infection of surgical sites and of intravenous catheters; the remaining diagnoses were grouped together. Two-thirds of all antibiotics prescribed were for the four most frequent diagnoses. Overall adherence to the guidelines was 71% and was highest in the most frequent diagnostic groups (76%). Eighty-one patients (65%) received IV antibiotic treatment. Forty-seven patients (58%) had a delayed switch from IV to PO (mean delay of 5.1 days) with 240 days of cumulative delay. This delay resulted in additional pharmacy costs and supplementary hospitalisation costs.
In general there was a good adherence to the local AB guidelines but we observed an unjustified delay in the switch from IV to PO in more than half of the patients, which started an IV antibiotic treatment.