Analysis of non-adherence to guidelines on rational antibiotic prescribing

Abstract

Background and objective Non-rational and excessive use of antimicrobial agents increases resistance to these preparations. The main goal of our study was to evaluate non-adherence (NA) to guidelines (NfG) on rational antibiotic therapy and prophylaxis (ABT/P). Design A cross-sectional study was performed in order to collect the data for patients receiving prescriptions for antimicrobial agents in January, 2006. Descriptive and comparative data were processed and evaluated using Graph Pad Prism 4 statistics program. Setting Tertiary KMU Hospital, 2600 beds, 34 departments. Main outcome measures The evaluation of NA to NfG. Analysis of the NA events according to profile of department, prescribing purpose (treatment or prophylaxis), selection (empirical or based on bacteriological tests), dosing features (too low/high) and spectrum (too broad/narrow). Results 331/1110 (29.82%) patients received antibiotics prescription. The significant correlation between the profile of department and the NA (r = - 0.9259, P = 0.0239, Pearson correlation coefficient). 206/331 (62.24%) cases of ABT/P were assessed as NA. Excluding Ocular department 91 NA cases were evaluated further. In NA cases mean (±SD) age was 49.27 (27.24%). NA cases consisted 34/76 (44.74%) cases in the departments of therapeutic profile; 30/56 (53.57%) in surgical profile; 23/61 (37.7%) in paediatric profile; and 0/6 (0%) in the intensive therapy profile. NA cases were considered in 58/160 (36.25%) in case of treatment and 33/49 (67.73%) in case of prophylaxis. The dependence between the NA and the type of the scope of antimicrobial prescribing (treatment or prophylaxis) was statistically significant (P = 0.0001, chi-square test). NA rate was 55/100 (55%) events in cases of empirical choice and 3/60 (5%) in case of treatment based on bacteriological tests. NA case analysis revealed too high dose prescribed in 27/91 (29.67%) cases, too [...].