Clinicians’ adherence to local antibiotic guidelines for upper respiratory tract infections in the ear, nose & throat casualty department of a public general hospital
Background:
In Malta, resistance to antibiotics constitutes a major
threat to public health. This study aims to assess
clinicians’ adherence to local antibiotic guidelines when
treating cases of acute otitis media, acute tonsillitis and
rhinosinusitis, that present to the ear, nose and throat
(ENT) casualty department in Malta’s public general
hospital, as well as to recommend methods for improving
adherence and minimising overprescribing.
Methodology:
Data on first line antibiotic prescribing regimens was
retrieved from ENT casualty sheets between February
and March 2015 for adult patients (>12years) diagnosed
with acute otitis media, acute tonsillitis and persistent
rhinosinusitis. On an audit form, aspects of the prescribed
antibiotic were benchmarked to local infection control
antibiotic guidelines of 2011 to evaluate adherence.
Results:
From 1010 casualty records, 188 were antibiotic
prescriptions, of which 93 (49.4%) were correctly
indicated as per guidelines. From the indicated
prescriptions 81 (87%) were assessable, out of which full
adherence was only observed in 6 (7%) of prescriptions.
All of these were for rhinosinusitis. Full adherence in
rhinosinusitis was found to be 43%, whilst no adherence
was found in the other infections. The most prescribed
antibacterial for all three infections was co-amoxiclav.
Conclusion:
The current antibiotic guidelines have not been
adequately implemented as adherence to antibiotic
choice alone was low in all infections. This may have an
impact on antibiotic-resistant rates and infection incident
rates. Hence to improve adherence to local antibiotic
guidelines, it is recommended that these should be clear,
regularly updated, well disseminated and reinforced.
The addition of a care pathway may further improve
appropriate antibiotic use.peer-reviewe