Limited effect of patient and disease characteristics on compliance with hospital antimicrobial guidelines

PGM Mol*, P Denig, ROB Gans, PV NannanPanday, JE Degener, M Laseur, FM Haaijer-Ruskamp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Scopus)
247 Downloads (Pure)

Abstract

Objective: Physicians frequently deviate from guidelines that promote prudent use of antimicrobials. We explored to what extent patient and disease characteristics were associated with compliance with guideline recommendations for three common infections. Methods: In a 1-year prospective observational study, 1,125 antimicrobial prescriptions were analysed for compliance with university hospital guidelines. Results: Compliance varied significantly between and within the groups of infections studied. Compliance was much higher for lower respiratory tract infections (LRTIs; 79%) than for sepsis (53%) and urinary tract infections (UTIs; 40%). Only predisposing illnesses and active malignancies were associated with more compliant prescribing, whereas alcohol/ intravenous drug abuse and serum creatinine levels > 130 mu mol/l were associated with less compliant prescribing. Availability of culture results had no impact on compliance with guidelines for sepsis but was associated with more compliance in UTIs and less in LRTIs. Narrowing initial broad-spectrum antimicrobial therapy to cultured pathogens was seldom practised. Most noncompliant prescribing concerned a too broad spectrum of activity when compared with guideline-recommended therapy. Conclusion: Patient characteristics had only a limited impact on compliant prescribing for a variety of reasons. Physicians seemed to practise defensive prescribing behaviour, favouring treatment success in current patients over loss of effectiveness due to resistance in future patients.

Original languageEnglish
Pages (from-to)297-305
Number of pages9
JournalEuropean Journal of Clinical Pharmacology
Volume62
Issue number4
DOIs
Publication statusPublished - Apr-2006

Keywords

  • guidelines
  • antibiotic policy
  • compliance
  • drug therapy
  • medical decision-making
  • URINARY-TRACT-INFECTIONS
  • COMMUNITY-ACQUIRED PNEUMONIA
  • ANTIBIOTIC GUIDELINES
  • RESISTANCE
  • NETHERLANDS
  • MANAGEMENT
  • ADULTS
  • PERSPECTIVE
  • ADHERENCE
  • OUTCOMES

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