A survey of inpatient antibiotic use in a teaching hospital

To assess the appropriateness of inpatient antibiotic use, a 4-week prospective survey in medical, surgical and gynaecological wards was undertaken at Groote Schuur Hospital. A total of 224 prescriptions comprising 680 antibiotics were analysed. Of all patients in the medical, gynaecology and surgery wards, 27%, 26.5% and 32%, respectively, were prescribed antibiotics. The greatest number of inappropriate prescriptions--54%--were found in the gynaecology ward. Prophylactic antibiotic use was highest in the surgical ward at 41% where a very satisfactory 91% was considered appropriate, whereas 66% of gynaecological prophylaxis was inappropriate. Therapeutic use was highest and more often appropriate in the medical wards. Antibiotics classified as restricted according to the hospital antibiotic policy were generally used appropriately, whereas inappropriate choice, dose, frequency of administration, duration, and unnecessary antibiotic use were encountered in 22-100% of cases with unrestricted antibiotics. Particular problems pinpointed in this survey included excessive dosages of penicillin G and amoxycillin, an irrational protocol for the treatment of pelvic sepsis in gynaecology, and frequent inappropriate selection of erythromycin. The greatest expenditure was on amikacin, the only aminoglycoside allowed according to the existing antibiotic policy.