oa Southern African Journal of Infectious Diseases - An evaluation of antibiotic prescribing patterns in adult intensive care units in a private hospital in KwaZulu-Natal : original research
The emergence of resistant microorganisms and its association with antimicrobial use is widely recognised as a global concern. Therefore, rational and regulated antimicrobial use is essential in both the public and private healthcare sectors in South Africa. A retrospective chart review was conducted of patients who were prescribed antibiotics over a two-month period. Prescriptions were assessed for adherence to the guidelines, either local or international, and/or to drug registration information, as a measure of rational prescribing practice. Accuracy of dose, and the frequency and duration of administration were evaluated, as were microbiologically informed treatment and de-escalation. 28.8% of patients (n = 226) received antibiotics during their intensive care unit (ICU) admission. A clear indication for antibiotic therapy was noted in 58.5% (n = 131) of the patients, of whom 70.2% were prescribed treatment consistent with the guidelines or drug registration information. Doses were deemed to be correct for 91.1% of the sample, microbiological investigations were evident for 61.2% of patients and de-escalation was noted in only 13.1% of the 70.8% of cases where de-escalation was indicated. Antibiotic prescription rates were relatively lower than those described in the international literature on antibiotic use in the ICU. Antibiotic prescription in the absence of indication in 41.1% of patients, the lack of microbiological verification in 38.8% of patients, inaccurate drug choice in 29.8% of the subset for whom antibiotics were indicated and incorrect dosing in 8.9% of the subset necessitates microbiologically informed therapy and compliance with the treatment guidelines.
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