The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands

Abstract

Objectives: Antimicrobial Stewardship Programs commonly have an in-hospital focus. Little is known about the quality of antimicrobial use in hospital outpatient clinics. We investigated the extent and appropriateness of antimicrobial prescriptions in the outpatient clinics of three hospitals. Methods: From June 2018 to January 2019, we performed ten point prevalence surveys in outpatient clinics of one university hospital and two large teaching hospitals. All prophylactic and therapeutic prescriptions were retrieved from the electronic medical records. Appropriateness was defined as being in accordance with guidelines. Furthermore, we investigated the extent to which the dose was adjusted to renal function and documentation of an antibiotic plan in the case notes. Results: We retrieved 720 prescriptions for antimicrobial drugs, of which 173 prescriptions (24%) were prophylactic. A guideline was present for 95% of prescriptions, of which the guideline non-adherence rate was 25.6% (n = 42/164) for prophylaxis and 43.1% (n = 224/520) for therapy. Of all inappropriate prescriptions (n = 266), inappropriate prescriptions for skin and soft tissue infections (n = 60/226) and amoxicillin-clavulanic acid (n = 67/266) made up the largest proportion. In only 13 of 138 patients with impaired or unknown renal function the dosage regimen was adjusted. Amoxicillin-clavulanic acid was the drug for which most often renal function was not taken into account. In 94.6% of prescriptions the antibiotic plan was documented. Conclusions: In hospital outpatient clinics, a substantial part of therapeutics were inappropriately prescribed. Amoxicillin-clavulanic acid was the most inappropriately prescribed drug, due to non-adherence to the guidelines and because dose adjustment to renal function was often not considered.

Appropriate Antibiotic Use and Associated Factors in Vietnamese Outpatients

“…However, since the criteria for the appropriate use assessment varied among individual studies, only a general comparison can be generated between study data. In brief, the percentage of appropriate antibiotic prescriptions in this study was higher than in previous studies in the country [16,28], and also higher than in some countries around the world [10][11][12]29,32,33]. However, in our sample population, there were a few elderly (20.2%) and children (1.9%) who received the antibiotics; this also means that vulnerability and multi-morbidity are less likely to affect decision-making on antibiotic prescribing of doctors and might be a supporting reason for the lower rate of inappropriate usage.…”

“…The inappropriate rate at an emergency department in Australia was reported with 32.7% throughout 2016 [32]. In the Netherlands, a recent study on antimicrobial use in the outpatient clinics showed that among 95% of prescriptions for which a guideline was present, the guideline non-adherence rate was 25.6% in term of antimicrobial agent, dose and duration [33]. However, since the criteria for the appropriate use assessment varied among individual studies, only a general comparison can be generated between study data.…”

Impact of a pilot multimodal intervention to decrease antibiotic use for respiratory infections in a geriatric clinic

“…In other studies, the highest rates of unnecessary prescribing have been noted for acute bronchitis, acute sinusitis, and viral upper respiratory infections, 6,13,23 where azithromycin, fluoroquinolones, and amoxicillin-clavulanate comprise a majority of the inappropriate antibiotic prescriptions. 7,8 Consistent with these studies, azithromycin was the most prescribed antibiotic in our population as well. Before the intervention, the geriatric clinic had higher use of narrower-spectrum antibiotics, particularly doxycycline, compared to previous studies 5,6 ; however, the intervention was able to limit the duration of antibiotics for those already prescribed the appropriate agent.…”

“…Prior large-scale studies have repeatedly demonstrated that antibiotics are overprescribed for outpatient acute respiratory conditions, 5,6 and the rate of inappropriate prescriptions ranges from 35% to 76% based on the specific condition. [6][7][8] Not only do inappropriate antibiotic prescriptions contribute to an increase in antimicrobial resistance, but antibiotics are also associated with serious adverse effects such as drug-drug interactions, allergic reactions, neurologic or psychiatric effects, and Clostridiodes difficile infection. 9 According to the US Centers for Disease Control and Prevention (CDC), there are 223,900 cases of C. difficile infection and >12,800 deaths yearly.…”

Antibiotic prescribing patterns for childhood infections in ambulatory settings in Jordan

“…Such finding was congruently highlighted in a study conducted by van den Broek et al where antibiotics accounted for 79% of prescriptions. 38 Narrow-spectrum antibiotics were more frequently prescribed compared with broad-spectrum antibiotics. This finding is consistent with recommendations of treating childhood infections using narrow-spectrum antibiotics, as such an approach would essentially improve treatment outcomes and control antimicrobial resistance.…”