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Concordance with antibiotic guidelines in Australian primary care: A retrospective study of prior‐to‐hospital therapy

O'Keefe, C, Thompson, A ORCID: 0000-0001-8677-0249, McKenzie, D and Lee, K ORCID: 0000-0003-3022-4868 2019 , 'Concordance with antibiotic guidelines in Australian primary care: A retrospective study of prior‐to‐hospital therapy' , International Journal of Clinical Practice , pp. 1-11 , doi: 10.1111/ijcp.13427.

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Background: Appropriate antibiotic prescribing improves patient outcomes and miti‐gates antimicrobial resistance. As the majority of antibiotics are used in the commu‐nity, rational prescribing in this setting is of paramount importance.Objectives: We aimed to (1) evaluate the concordance of community antibiotic pre‐scribing with guidelines for three common infection types among patients who pre‐sented to hospital, and (2) identify relationships between guideline concordance andpatient‐related factors.Methods: Medical records were evaluated from the Royal Hobart Hospital (Tasmania,Australia) for patients presenting with respiratory tract, urinary tract or skin and softtissue infections within a 12‐month period. Prior‐to‐hospital antibiotic therapy wasassessed for concordance with prescribing guidelines based on presenting diagno‐sis. Concordance was assessed against first‐line recommendations in the AustralianTherapeutic Guidelines ‐ Antibiotic, based on drug choice, dose, frequency andpatient factors. Descriptive statistics were performed to address Objective 1.Multivariate logistic regressions were conducted to address Objective 2 with the fol‐lowing independent variables: infection type, age, allergies, diabetes status, genderand residential setting.Results: A total of 285 patient records were eligible for data analysis; 28.8% (n = 82)were fully guideline concordant. The most common reason for non‐concordancewas inappropriate drug choice (n = 143, 50.2%). Patients with the following charac‐teristics were less likely to receive concordant therapy: diabetes (OR = 0.3, 95% CI0.1‐0.8, P = .02) and increasing age (OR = 0.99, 95% CI 0.98‐1.00, P = .04).Conclusions: Almost three‐quarters of patients received community‐initiated an‐tibiotic therapy that was not fully guideline concordant. Antimicrobial stewardshipinterventions are urgently needed to improve guideline concordance for community‐initiated antibiotic therapy.

Item Type: Article
Authors/Creators:O'Keefe, C and Thompson, A and McKenzie, D and Lee, K
Keywords: antibiotics, prescribing, stewardship, resistance, guidelines
Journal or Publication Title: International Journal of Clinical Practice
Publisher: Blackwell Publishing Ltd
ISSN: 1368-5031
DOI / ID Number: 10.1111/ijcp.13427
Copyright Information:

Copyright 2019 John Wiley & Sons Ltd

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