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


O'Keefe, C and Thompson, A and McKenzie, D and Lee, K, Concordance with antibiotic guidelines in Australian primary care: a retrospective study of prior‐to‐hospital therapy, International Journal of Clinical Practice, 73, (12) Article e13427. ISSN 1368-5031 (2019) [Refereed Article]

Copyright Statement

Copyright 2019 John Wiley & Sons Ltd

DOI: doi:10.1111/ijcp.13427


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 and patient‐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 soft tissue infections within a 12‐month period. Prior‐to‐hospital antibiotic therapy was assessed for concordance with prescribing guidelines based on presenting diagno‐ sis. Concordance was assessed against first‐line recommendations in the Australian Therapeutic Guidelines ‐ Antibiotic, based on drug choice, dose, frequency and patient 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, gender and 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‐concordance was 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% CI 0.1‐0.8, 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 stewardship interventions are urgently needed to improve guideline concordance for community‐ initiated antibiotic therapy.

Item Details

Item Type:Refereed Article
Keywords:antibiotics, prescribing, stewardship, resistance, guidelines
Research Division:Biomedical and Clinical Sciences
Research Group:Pharmacology and pharmaceutical sciences
Research Field:Clinical pharmacology and therapeutics
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Thompson, A (Mr Angus Thompson)
UTAS Author:Lee, K (Dr Kenneth Lee)
ID Code:135137
Year Published:2019
Web of Science® Times Cited:2
Deposited By:Pharmacy
Deposited On:2019-10-02
Last Modified:2021-01-19

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