Healthy Skepticism Library item: 5562

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Publication type: Journal Article

Ali MH, Kalima P, Maxwell SR.
Failure to implement hospital antimicrobial prescribing guidelines: a comparison of two UK academic centres.
J Antimicrob Chemother 2006 May 01; 57:(5):959-62
http://jac.oxfordjournals.org/cgi/content/full/57/5/959

Abstract:

BACKGROUND: Rational antimicrobial therapy should provide maximum benefit to patients while minimizing the development of resistant microorganisms. OBJECTIVES: The aim of this study was to investigate (i) which antimicrobial drugs were chosen by hospital doctors faced with two common infections [community-acquired pneumonia (CAP) and urinary tract infection (UTI)], (ii) whether these choices were compliant with local guidance and (iii) the factors that influenced antimicrobial choice. METHODS: A questionnaire based on two hypothetical clinical scenarios was distributed to 316 hospital doctors across four UK NHS hospitals in two cities (Newcastle and Edinburgh). RESULTS: Doctors in Newcastle were significantly more aggressive in their management: more patients were admitted (CAP: 78.9% versus 48.4%, P < 0.05) and given antimicrobials intravenously (CAP: 53.4% versus 21.2%, P < 0.05). Adherence to the local hospital guideline for CAP was significantly higher in Newcastle (83.3% versus 38.0%; P < 0.05). Fewer than half of the doctors surveyed used the local hospital guideline when choosing an antimicrobial, and the British National Formulary was the most frequently used resource (>90%). Junior doctors also identified medical school teaching and opinions of senior doctors as important influences. CONCLUSIONS: This study highlights inadequacies in the implementation and promotion of local guidelines, and demonstrates the potential for widely varying antimicrobial practices in two comparable UK cities.

Keywords:
Anti-Bacterial Agents/administration & dosage Anti-Bacterial Agents/therapeutic use* Attitude of Health Personnel* Community-Acquired Infections/drug therapy Comparative Study Great Britain Guideline Adherence* Hospitals, General Humans Physician's Practice Patterns* Pneumonia, Bacterial/drug therapy Prescriptions, Drug* Questionnaires Urinary Tract Infections/drug therapy