A study aimed at quantifying excess antibiotic use in an acute UK hospital found that nearly a quarter of antibiotic days of therapy (DOTs) were unnecessary.
The most significant opportunity to reduce antibiotic use came in optimising the pre-72 hours antibiotic review. Other important opportunities to reduce use included avoiding inappropriate initiation of antibiotics and ensuring course lengths were appropriate for each patient.
Patients discharged from a district general hospital in south-west England in August 2020 who had received antibiotics were monitored using an audit tool to evaluate and measure the use of antibiotics. Two infection specialists then determined the appropriateness of antibiotic use and calculated the DOTs.
Of the 647 patients discharged during the study, 184 were reviewed for antibiotic use. In total, 1,658 DOTs were administered across all patients in the study. Nearly a quarter of the DOTs (24%, n=403) were excess days when antibiotic use was unnecessary.
Half of the patients reviewed (n=92) were prescribed antibiotics for longer than was clinically necessary, contributing to the excess DOTs.
Nearly half of the excess DOTs (45.7%) occurred before the 72-hour review and over a quarter (27.8%) at initiation of therapy, where antibiotics were taken for too long or unsuitable medications were chosen. Inappropriately long courses of antibiotics contributed 26.6% of DOTs.
The findings suggest that addressing antibiotic use at the three time points of initiation, review and duration could significantly reduce unnecessary use, leading to improved patient outcomes and a reduction in antibiotic resistance.
The researchers hope the findings may provide a target for reducing excess antimicrobial therapy in line with the national antimicrobial resistance (AMR) strategy and improve future prescribing habits.
Reference
Owens, R et al. Assessment of the appropriateness of antibiotic prescribing in an acute UK hospital using a national audit tool: a single centre retrospective survey. European Journal of Hospital Pharmacy 2024; Oct 25: DOI: 10.1136/ejhpharm2022-003569.
