Assessment of appropriateness of restricted antibiotic use in Charoenkrung Pracharak Hospital, a tertiary care hospital in Bangkok, Thailand.

ABSTRACT

The purpose of this study was to evaluate the appropriate of restricted antibiotics at a tertiary care hospital in Bangkok, Thailand. Data from patient charts during September-November, 2009 were obtained regarding appropriate use of antibiotics following hospital antibiotic guidelines. Of 307 prescriptions reviewed, the prevalence of appropriate antibiotic use was 74.6% (229/307). Most patients were male (185/307) with a mean age of 64.2 +/- 18.0 years. There was a significant association between appropriate antibiotic use and patients having underlying disease, a previous history of recent antibiotic use, a recent hospitalization, admission to a medical unit and having a recent health-care institution acquired infection (p < 0.001). The diagnosis of pneumonia was associated with proper use of antibiotics compared with other diagnoses (OR 1.8). Admission to a medical ward was more likely to be associated with correct antibiotic use than having surgery (OR 7.8 and 0.07). Having a health-care institution acquired infection more likely to be associated with appropriate antibiotic use than having a community acquired infection (OR 5.5 and 0.13). Meropenem was more likely to be used appropriately than cefoperazone/sulbactam (OR 1.9 and 0.2). After multivariate analysis, controlling confounding factors, admission to a medical unit and having a health-care institution acquired infection were factors associated with proper use of restricted antibiotics (adjusted OR 9.0 and 7.1; 95% CI 2.27-35.73 and 2.38-20.95; p = 0.002 and p < 0.001, respectively). The prevalence of appropriate use of restricted antibiotics was high; physicians followed local hospital antibiotic guidelines. Future studies of compliance with hospital antibiotic guidelines and its impact on bacterial resistance and infection related mortality should be carried out to determine if appropriate antimicrobial use leads to improve outcomes.