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Antibiotic Prescribing at Advanced Care at Home in Stockholms Sjukhem: Compliance with National Guidelines
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences, Division of Pharmacokinetics and Drug Therapy.
2018 (English)Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
Abstract [en]

Irrational use of antibiotics has been reported in nursing homes and hospice care worldwide, although guidelines for appropriate antibiotic use are available. Information about antibacterial drug usage and factors influencing their use are required in order to improve the quality of prescription practices.

Purpose: The aim of this report was to assess whether or not antibiotic prescriptions in ASIH-units were in accordance with national guidelines. This study was conducted since there are no previous studies on antibiotic use in Stockholms Sjukhem advanced healthcare at home (ASIH) units in relation to Swedish guidelines.

Methods: Methodology triangulation was used to combine quantitative and qualitative method for the collection of data. In qualitative section, a face-to-face interview was conducted with two physicians. In quantitative section, medicament lists, medical – and laboratory records of residents prescribed systemic antibiotics during a period of three months were reviewed. Data was collected via point prevalence study (PPS) questionnaires. Use of systemic antibiotics (ATC group J01) were evaluated based on Swedish guidelines.

Results: A total 102 of 184 residents received antibacterial drugs, of whom 63 residents were prescribed antibiotics in ASIH. Of the 63 residents receiving antibiotics, 57 residents (85%) were prescribed antibiotics for a suspected infection, 7 residents (10%) were prescribed prophylactic treatment and 3 (5%) patients received both prophylaxis and treatment simultaneously. Indication for antibiotics were in 38% of the cases urinary tract infections (UTI), in 18% skin and soft tissue infection, in 17% missing diagnosis, 12% respiratory tract infections (RTI) and in 15 % other infections. The antibiotics most frequently used were penicillins (47%), followed by cephalosporins (16%) and nitrofurantoin (10%). Irrational use of antibiotics was common in ASIH-units (95% CI 0.69-0.89, c2 =10.2, p=0.0014). Inappropriate antibiotic use was more common in RTIs (86%) and UTIs (82%). The compliance to guidelines for empirical treatment and selection of antibiotics for infection treatments were low and it was followed by duration of therapy and dosage. Incorrect route of administration and non-performed bacteriological cultures were not common in ASIH. Results from the interview indicate factors that may have influenced the observed prescription pattern.

Conclusion: The high proportion of inappropriate antibiotic use in Stockholms Sjukhem ASIH-units underlines the need for increased focus on rational prescribing in the ASIH-units. Prescribing antibacterial drugs according to bacteriological test results and national guidelines, whenever it is possible, could decrease the inappropriate use of antibiotics. Further studies should focus on developing guidelines for this patient population in order to be able to use antibiotics in the best possible manner. 

Place, publisher, year, edition, pages
2018. , p. 32
Keywords [en]
antibiotic use; advanced care at home; antibacterials
National Category
Pharmaceutical Sciences
Identifiers
URN: urn:nbn:se:uu:diva-360073OAI: oai:DiVA.org:uu-360073DiVA, id: diva2:1246980
Subject / course
Pharmacotherapy
Educational program
Master of Science Programme in Pharmacy
Supervisors
Examiners
Available from: 2018-10-15 Created: 2018-09-10 Last updated: 2018-10-15Bibliographically approved

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