Antimicrobial prescribing in the surgical and medical wards at a private hospital in KwaZulu-Natal.
Jacob, Valencia Tamzyn.
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Background: Appropriate antimicrobial use is imperative due to the misuse of antimicrobials that has resulted in a growing burden of antimicrobial resistance. Evidence-based guidelines should be adhered to in order to ensure the sustainability of effective antimicrobials. Objectives: To assess the appropriateness of antimicrobial prescribing at a private hospital in Durban, KwaZulu-Natal. Methods: The records of patients admitted to the surgical and medical wards from June 2019 to July 2019 were reviewed to assess the choice of antimicrobials prescribed, dose and duration. The guidelines used to determine appropriateness were the Standard Treatment Guidelines and the Essential Medicines List for South Africa (hospital level for adults, 2015 edition), the South African Medicines Formulary (13th edition, 2019), the South African Antibiotic Stewardship Programme guidelines (2014 edition) and the evidence-based surgical prophylaxis guidelines (2017 edition) developed by the hospital group where the research was conducted. Results: During the study period, 466 patients were admitted and prescribed an antimicrobial, of which 220 (47.2%) were admitted to the surgical ward and 246 (52.8%) were admitted to the medical wards. A total of 779 antimicrobials were prescribed. Of the 660 antimicrobials prescribed for empiric treatment, 305 (46.2%) antimicrobials were appropriately prescribed based on drug choice, dose and duration. Of the 38 antimicrobials that were classified as targeted, 36 (94.7%) were prescribed according to the correct dose and 33 (86.8%) were prescribed according to the correct duration. Of the 81 antimicrobials prescribed for surgical prophylaxis, only 32 (39.5%) met the criteria for appropriateness in terms of drug choice, dose and duration. Conclusion: Our findings suggest that compliance with evidence-based guidelines for the use of antimicrobials is not optimal in hospitals in the private sector. Antimicrobials are prescribed inappropriately both for empiric treatment and for surgical prophylaxis. Private hospital groups should consider adopting antimicrobial prescribing guidelines that are mandatory for doctors to adhere to in order to promote rational antimicrobial prescribing and thereby reduce the burden of antimicrobial resistance.