Clinicians’ adherence to local antibiotic guidelines for upper respiratory tract infections in the ear, nose throat casualty department of a public general hospital

摘要

Background: udIn Malta, resistance to antibiotics constitutes a majorudthreat to public health. This study aims to assessudclinicians’ adherence to local antibiotic guidelines whenudtreating cases of acute otitis media, acute tonsillitis andudrhinosinusitis, that present to the ear, nose and throatud(ENT) casualty department in Malta’s public generaludhospital, as well as to recommend methods for improvingudadherence and minimising overprescribing.udMethodology:udData on first line antibiotic prescribing regimens wasudretrieved from ENT casualty sheets between Februaryudand March 2015 for adult patients (>12years) diagnosedudwith acute otitis media, acute tonsillitis and persistentudrhinosinusitis. On an audit form, aspects of the prescribedudantibiotic were benchmarked to local infection controludantibiotic guidelines of 2011 to evaluate adherence.udResults:udFrom 1010 casualty records, 188 were antibioticudprescriptions, of which 93 (49.4%) were correctlyudindicated as per guidelines. From the indicatedudprescriptions 81 (87%) were assessable, out of which fulludadherence was only observed in 6 (7%) of prescriptions.udAll of these were for rhinosinusitis. Full adherence inudrhinosinusitis was found to be 43%, whilst no adherenceudwas found in the other infections. The most prescribedudantibacterial for all three infections was co-amoxiclav. udConclusion:udThe current antibiotic guidelines have not beenudadequately implemented as adherence to antibioticudchoice alone was low in all infections. This may have anudimpact on antibiotic-resistant rates and infection incidentudrates. Hence to improve adherence to local antibioticudguidelines, it is recommended that these should be clear,udregularly updated, well disseminated and reinforced.udThe addition of a care pathway may further improveudappropriate antibiotic use.