The impact of appropriate antibiotic prescribing on treatment evaluation parameters

Abstract

The therapeutic impact of inappropriate prescribing of antibiotics is debatable, particularly in situations where infections are treated empirically with multiply prescribed antibiotics. Prescribers may remain under the illusion that such prescriptions are appropriate on the basis of any observed positive treatment outcomes, even though an antibiotic prescribed in such combination therapy may actually be infective against infecting pathogens. This, inevitably, promotes inappropriate antibiotic prescribing. Prescribers may be motivated to make more conscious attempts to prescribe antibiotics appropriately if it is proven that judicious prescribing of antibiotics has positive impacts on treatment outcomes. The objective of this study was to determine the impact of appropriate prescribing of antibiotics on treatment outcomes, days of patient hospitalization and costs related to antibiotic treatment. Observational data on antibiotic treatment were collected for a one-month period from case notes of all inpatients (n=307) and outpatients (n=865) at five government and mission hospitals in Lesotho. Prescriptions were classified into categories of appropriateness based on extents to which antibiotics were prescribed according to principles. Treatment success rates, mean days of hospitalization and costs of antibiotic treatments of inpatients treated with specified prescription categories were determined. Appropriate prescribing of antibiotics for inpatients had positive impacts on treatment outcomes, patients’ days of hospitalization for infections and costs of antibiotic treatments. In outpatient settings, appropriate prescribing of antibiotics failed to show any significant impact on costs of antibiotics. Appropriate prescribing of antibiotics had a positive impact on patients’ recovery and costs of antibiotic treatments in inpatient settings.

Surgical Antimicrobial Prophylaxis and Incidence of Surgical Site Infections at Ethiopian Tertiary-Care Teaching Hospital

“…This result was similar to a study done in Namibia. 34 The most commonly used antibiotic was ceftriaxone for both indications, and it was the most commonly prescribed antibiotic in combination with other antibiotics in this study. This might be due to unavailability of the appropriate SAP agent like cefazolin.…”

Compliance to guidelines for the prescribing of antibiotics in acute infections at Namibia’s national referral hospital: a pilot study and the implications

“…This is mainly due to treatment policies and guidelines recommending the use of J01C antibiotics as first line antibiotics for most acute in infections including respiratory, gastrointestinal and genitourinary and musculoskeletal infections [64]. Whilst Pereko and colleagues reported that most isolated bacterial pathogens had high sensitivity to amoxicillin, the overuse of these penicillins for ARIs has been associated with resistance in the public sector, and poses a potential selective pressure on this class of medicines [22,23,26,36,64].…”

“…The unnecessary use of antibiotics has been associated mainly with outpatient department (OPD) related illnesses [35], particularly acute upper respiratory infections (URTIs) [6,34,[36][37][38] and diarrhoea -related illnesses [39]. The majority of infections in OPD care are acute and of viral origin [31,38,40,41], which do not necessitate antibiotics [18,42,43].…”

Assessment of the appropriateness of antibiotic prescriptions in Lesotho public hospitals: a novel methodology based on principles of antibiotic prescribing

“…It also provides details of the methodology we used to develop an antibiotic prescription classification system as reported in our earlier published work on the impact of appropriate antibiotic prescribing on treatment evaluation parameters. 8 Our methodology also demonstrated an added advantage of providing data that could be analyzed to make information available on sources of inappropriate prescribing in respect to specified criteria. We consider such information useful in formulating antibiotic prescribing policies aimed at promoting appropriate prescribing.…”