The impact of antibiotic policy on prescribing in a London teaching hospital. A one-day prevalence survey as an indicator of antibiotic use.

Abstract

To assess current antibiotic use and the impact on prescribing of hospital antibiotic policy, a prospective one-day prevalence survey of antibiotic use in both in-patients and out-patients was undertaken at St Thomas' Hospital. Of 921 in-patients, 196 (21%) received 269 antibiotic prescriptions on the survey day. Approximately 40% of in-patients received prophylaxis and 60% received treatment. Among 1521 out-patients, 292 (19%) were given a prescription on the survey day and 102 (7%) received an antibiotic prescription. Assessment of in-patient use with reference to the current hospital antibiotic policy was made mainly on microbiological grounds, on choice and dosage of agents. Choice of antibiotic was largely in accord with antibiotic policy, but was considered inappropriate in 12.5% of 81 in-patients given prophylaxis and 2.5% of 120 in-patients given treatment. Dosage of some major agents and timing of surgical prophylaxis was also considered inappropriate in many patients. A simple one-day survey is a useful indicator of antibiotic use in the hospital, and shows where further guidance to prescribers could be provided.