Background

A retrospective audit was conducted in September 2024 in 10 wards to identify the prevalence and antibiotic prescription patterns at National Hospital for Respiratory Diseases (NHRD), Sri Lanka. This audit aim to improve rational use of the Antibiotic usage at National Hospital for Respiratory Diseases, Welisara, Sri Lanka.

Method 

Data on antibiotic use was extracted from Bed Head Tickets (BHTs) from each unit using a standard questionnaire form. 

Result 

A retrospective analysis of 142 patient records revealed a female representation of 37.32% (n=53) and a mean cohort age of 54.64 years. Antimicrobial therapy was administered to 115 patients (81%), with the highest prevalence of use observed within surgical units. The majority of these prescriptions were attributed to community-acquired infections.

The primary clinical indications for antibiotic initiation were:

Secondary respiratory infections in smear-positive post-tuberculosis patients: 34.61%

Pneumonia: 20.15%

Post-plural effusion respiratory infections: 9.0%

Empiric prescribing accounted for 69.5% (n=80) of all instances. Regarding administration routes, 96 patients received intravenous (IV) therapy and 88 received oral therapy, with a subset receiving concurrent IV and oral treatments. Multi-drug regimens were common; 57.39% (n=66) of patients were prescribed two antibiotics, while 3.4% (n=4) received three or more.

The most frequently utilized medications were:

Oral: Co-amoxiclav (n=38) and Clarithromycin (n=30).

Intravenous: Ceftriaxone (n=26) and Meropenem (n=18).

Notably, the clinical rationale for starting antibiotics was undocumented in 9.2% (n=12) of cases. While no sub-therapeutic dosing was reported, significant gaps in diagnostics were identified: appropriate microbiological cultures were not requested for 25 patients, and relevant data were missing from 30 Bed Head Tickets (BHTs).

Conclusion

This audit highlights a high prevalence of antibiotic utilization and identifies specific lapses in the documentation of clinical indications. Fluctuations in prescribing patterns were observed, likely secondary to the transfer of medical officers and consultants.

To strengthen antibiotic stewardship, it is imperative to enforce adherence to national guidelines for empirical and prophylactic therapy. Furthermore, regular reviews of indications, dosages, and treatment duration by a Consultant Microbiologist are recommended to foster more rational antimicrobial prescribing.