Antimicrobial prescribing patterns at a rural hospital in Trinidad: evidence for intervention measures

The antibiotic prescribing patterns on 527 case notes of discharged patients over a two-month period at a teaching hospital in southern Trinidad were retrospectively analyzed. Forty four percent of patients had received one or more antibiotics. The greatest exposure rate was on the orthopedic (79.4%), pediatric (70.8%), and obstetric/gynecology (64%) services. Genital tract infections, urinary tract infections, skin/ soft tissue infections and lower respiratory tract infections were the commonest indications for antibiotic prescription. The antibiotics most frequently prescribed were ampicillin (53.4%), chloramphenicol (16.5%) and gentamicin (11.3%). Ninety-six (41.0%) patients were described as being allergic to penicillin, and of these, 5 received ampicillin and 3 received cefaclor. Poor communication and lack of confidence in laboratory technician expertise were identified as possible cofactors partly responsible for most inappropriate antibiotic use in the hospital. The study also revealed that prevailing prescribing patterns at the SFGH might be improved through refresher training of doctors in clinical microbiology and the identification of clinical areas for which targeted antibiotic intervention may be warranted.