Abstract

DIVERSION FROM ADULTS ANTIBIOTIC CLINICAL GUIDELINES: A STUDY AT THE MEDICAL DEPARTMENT; AL HADA MILITARY HOSPITAL, TAIF, KSA.

Dr. Abuabker Ibrahim Elbur*, Dr. Shaikh Muhammad Saif Din, Dr. Mansour Alghamdi and Dr. Hisham A Felemban

ABSTRACT

Background: Antibiotic clinical guidelines ensure the appropriateness of treatment, improve quality of care, reduce the level of resistant organisms and finally promote evidence –based decision making. Objectives: To measure diversion from adults antibiotic clinical guidelines with regards to the initiation of antibiotic therapy for infectious episodes and to identify predictors of diversion, if any Methods: A cross-sectional study was conducted during the period of September 2015- February 2016 at the Medical Department in Al – Hada Military Hospital, Taif, Saudi Arabia. Data was collected by mean of a standardized case record. Data were analyzed by the Statistical Package for Social Sciences (SPSS, version 22). Logistic regression analysis was performed. P value < 0.05 was considered statistically significant. Results: A total of 107 patients was included, of them 58 (54.2%) were males. The majority of the cases had other comorbidities. A total of 188 antibiotics was prescribed, of these 149 (79%) were given empirically, while 39 (21%) ordered for definitive therapy. Of all episodes 60 (58.1%) were treated in accordance with the guidelines, while 47 (43.9%) were diverted. Previous hospitalization identified as significant predictor of diversion from the guidelines (P= 0.02), along with the Gram stain results (P= 0.04) which had inverse relationship with the diversion from the guideline (odds ratio was < 1.0). The most inaccurate doses were observed in the beta lactam beta lactamase inhibitors class 18 (60%) followed by the cephalosporin 6 (20%). Appropriateness of frequency of administration was observed in 149 (79.3%) prescriptions. Conclusion: Almost for more than half of the episodes initiation of antibiotic therapy was deviated from the guidelines. Significant errors in dosing were found too. Urgent educational and managerial interventions to improve prescribers commitment to these guidelines are needed.

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