Identifying barriers to the rapid administration of appropriate antibiotics in community-acquired pneumonia

Barlow, Gavin; Nathwani, Dilip; Myers, Elizabeth A.; Sullivan, Frank; Stevens, Nicola; Duffy, Rebecca; Davey, Peter

doi:10.1093/jac/dkm462

Cited by 57 publications

(48 citation statements)

References 24 publications

(30 reference statements)

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“…Lastly, our study results may have been different if carried out in more than three hospitals. However, the number of participating physicians is quite large as compared with other studies [7,21], and physicians working in a teaching hospital as well as in a university hospital setting were included. Therefore, we feel that our results adequately reflect current practice in the Netherlands.…”

Section: Discussionmentioning

confidence: 99%

Barriers to an early switch from intravenous to oral antibiotic therapy in hospitalised patients with CAP

Engel

Postma

Hulscher³

et al. 2012

European Respiratory Journal

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Do physicians apply an early-switch strategy (from intravenous to oral antibiotics) in clinically stable patients hospitalised with community-acquired pneumonia (CAP)? If not, why not?In a multicentre prospective cohort study, adult patients admitted for i.v. CAP treatment were included. On day 3 of antibiotic treatment, clinical stability was assessed and treating resident physicians were interviewed on their switch strategies. Additionally, treating physicians were interviewed to evaluate their knowledge of and adherence to guideline advice.149 (92%) out of 162 patients were included and 97 (91%) out of 107 physicians were interviewed. A switch to oral antibiotics was possible in 68 (46%) out of 149 patients on day 3 of treatment but not performed in 27 (40%) out of 68. Patient factors delaying the switch were high CURB-65 (confusion of new onset, urea .7 mmol?L -1 , respiratory rate of o30 breaths?min -1 , blood pressure ,90 mmHg or diastolic blood pressure f60 mmHg, and age o65 yrs) score (on admission) (p50.04) and oxygen treatment (p50.04), high temperature (p50.00) and high respiration rate (p50.04) (day 3). Physicians' barriers to an early switch in clinically stable patients included misconceptions (26 (55%) out of 47), practical considerations (13 (28%) out of 47) and organisational factors (eight (17%) out of 47). Strikingly, 91 (94%) out of 97 interviewed physicians were not aware of guideline advice. The switch from i.v. to oral antibiotics is often unnecessarily delayed in patients hospitalised with CAP due to different types of barriers.

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Section: Discussionmentioning

confidence: 99%

Barriers to an early switch from intravenous to oral antibiotic therapy in hospitalised patients with CAP

Engel

Postma

Hulscher³

et al. 2012

European Respiratory Journal

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“…In general, organizational obstacles such as delay in performing or lack of a system to review the required investigations, inconsistent antibiotic availability, and work intensity in the presence of other issues like weak triage system possibly play a role [26]. Likewise, lack of senior support for junior staff or no audit of the prescribed antibiotic regimen and failure to change a familiar ward-popular antibiotic or combination of antibiotics have been shown to influence the empirical and other policy-related guidelines [27,28].…”

Section: Discussionmentioning

confidence: 99%

Audit of Physicians’ Adherence to the Antibiotic Policy Guidelines in Kuwait

Aly¹,

Omar

Badawy

et al. 2012

Med Princ Pract

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Objective: To audit physicians’ adherence to the local antibiotic policy guidelines in government hospitals in Kuwait. Materials and Methods: The study was a retrospective review of patient records in nine hospitals between July 1 and December 31, 2008. Clinical notes and medication charts of the latest hospital admissions were checked for antibiotic prescribing. On the audit form, aspects of the prescribed antibiotic were benchmarked to the hospital antibiotic policy guidelines to evaluate adherence. Results: Of 2,232 reviewed records, 1,112 (49.8%) patients had 1,528 antibiotic prescriptions. Patients who received antibiotics were significantly younger than those who did not (median age: 26.3 vs. 29.8 years, p < 0.001) and their hospital stay was significantly longer (median: 4 vs. 2 days, p < 0.001). The choice of an antibiotic was appropriate and matched the policy in 806 (52.7%) prescriptions. Of such appropriate antibiotics, adherence to route of administration was observed in 768/806 (95.3%), to dose in 758 (94%), to frequency in 746 (92.6%) and to duration in 608 (75.4%). Full adherence to all aspects of antibiotic choice, dose, route, frequency and duration was achieved in 464 (30.4%) prescriptions. In 382 (25%), the antibiotics administered were not indicated. Conclusion: There was low adherence to the local antibiotic policy guidelines. Physicians’ antibiotic prescribing practices should be optimized. Adherence to, and update of, the policy is recommended.

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“…A recent study has pointed to the difficulties involved in de-escalating treatment in ''realworld'' practice, including for non-life-threatening urinary tract infections due to antibiotic-sensitive E. coli [25]. Nonadherence to the practice guidelines that have been issued regarding antimicrobial therapy is not uncommon when treating bacteraemia [26] or pneumonia [27], though it must be overcome with a view to improving clinical outcomes. Emphasis at the bedside by disseminating evidence-based knowledge and by motivating healthcare providers may be a solution [28].…”

Section: Discussionmentioning

confidence: 99%

De-escalation of antimicrobials in the treatment of bacteraemia due to antibiotic-sensitive pathogens in immunocompetent patients

2011

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Identifying barriers to the rapid administration of appropriate antibiotics in community-acquired pneumonia

Cited by 57 publications

References 24 publications

Barriers to an early switch from intravenous to oral antibiotic therapy in hospitalised patients with CAP

Barriers to an early switch from intravenous to oral antibiotic therapy in hospitalised patients with CAP

Audit of Physicians’ Adherence to the Antibiotic Policy Guidelines in Kuwait

De-escalation of antimicrobials in the treatment of bacteraemia due to antibiotic-sensitive pathogens in immunocompetent patients

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