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Published on: August 30, 2018
Potential to reduce antibiotic use in secondary care: Single-centre process audit of prescription duration using NICE
Neil Powell1, Jennie Stephens2, Rory Rule2
1Royal Cornwall Hospital Trust, Treliske, UK and honorary clinical school fellow, University of Plymouth, Plymouth, UK neil.powell2@nhs.net.
Introduction:
Antibiotic use drives antibiotic resistance. Reducing antibiotic use through reducing antibiotic course lengths could contribute to the UK national ambition to reduce total antibiotic use.
Methods:
Medical notes were reviewed for patients who had received at least 5 days of antibiotic therapy; had been discharged in January 2019; and were from a 750-bed acute secondary care hospital in England. UK national guidelines were used to determine the excess antibiotic use in common medical infections: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), pyelonephritis, cellulitis, infective exacerbation of chronic obstructive pulmonary disease (IECOPD) and cholangitis.
Results:
Four-hundred and twenty-three patients met the inclusion criteria. Of these, 307 (73%) patient notes were retrieved and reviewed. One-hundred and seventy-three patients met the study case definitions, of which, 137 met short course criteria.Potential antibiotic reductions (measured in defined daily doses) were identified for five of the six infections: 32% in CAP, 20% in HAP, 14% in IECOPD, 11% in cellulitis and 10% in pyelonephritis. These reductions were estimated to reduce total antibiotic use in medical specialties by 12.4%, which equates to 3.6% of the hospital's total antibiotic use.
Conclusion:
Clinical application of the evidence-based guidance for shorter antibiotic course lengths appears to be a valid strategy for reducing total antibiotic consumption.
Insights
Reducing antibiotic course lengths can significantly decrease overall antibiotic use in hospitals. This strategy supports national efforts to combat antibiotic resistance by optimizing treatment durations for common infections.
Area of Science:
- Medical research
- Infectious diseases
- Antimicrobial stewardship
Background:
- Antibiotic use is a primary driver of antibiotic resistance, a major global health concern.
- Reducing overall antibiotic consumption is a key objective for national health systems, including in the UK.
Purpose of the Study:
- To evaluate the potential for reducing antibiotic course lengths in a UK hospital setting.
- To quantify the impact of shorter antibiotic courses on total antibiotic use.
Main Methods:
- Retrospective review of medical records for patients receiving at least 5 days of antibiotic therapy.
- Application of UK national guidelines to identify excess antibiotic use in common infections.
- Calculation of potential antibiotic reductions in defined daily doses.
Main Results:
- Analysis of 307 patient records revealed potential antibiotic reductions for five common infections.
- Estimated reductions varied by infection: 32% for community-acquired pneumonia (CAP), 20% for hospital-acquired pneumonia (HAP), 14% for infective exacerbation of chronic obstructive pulmonary disease (IECOPD), 11% for cellulitis, and 10% for pyelonephritis.
- Overall reduction estimated at 12.4% in medical specialties, equating to 3.6% of the hospital's total antibiotic use.
Conclusions:
- Implementing evidence-based guidance for shorter antibiotic courses is a viable strategy.
- This approach can effectively reduce total antibiotic consumption in acute secondary care settings.
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