Clinicians’ adherence to local antibiotic guidelines for upper respiratory tract infections in the ear, nose & throat casualty department of a public general hospital

Abstract

Background: In Malta, resistance to antibiotics constitutes a major threat to public health. This study aims to assess clinicians’ adherence to local antibiotic guidelines when treating cases of acute otitis media, acute tonsillitis and rhinosinusitis, that present to the ear, nose and throat (ENT) casualty department in Malta’s public general hospital, as well as to recommend methods for improving adherence and minimising overprescribing. Methodology: Data on first line antibiotic prescribing regimens was retrieved from ENT casualty sheets between February and March 2015 for adult patients (>12years) diagnosed with acute otitis media, acute tonsillitis and persistent rhinosinusitis. On an audit form, aspects of the prescribed antibiotic were benchmarked to local infection control antibiotic guidelines of 2011 to evaluate adherence. Results: From 1010 casualty records, 188 were antibiotic prescriptions, of which 93 (49.4%) were correctly indicated as per guidelines. From the indicated prescriptions 81 (87%) were assessable, out of which full adherence was only observed in 6 (7%) of prescriptions. All of these were for rhinosinusitis. Full adherence in rhinosinusitis was found to be 43%, whilst no adherence was found in the other infections. The most prescribed antibacterial for all three infections was co-amoxiclav. Conclusion: The current antibiotic guidelines have not been adequately implemented as adherence to antibiotic choice alone was low in all infections. This may have an impact on antibiotic-resistant rates and infection incident rates. Hence to improve adherence to local antibiotic guidelines, it is recommended that these should be clear, regularly updated, well disseminated and reinforced. The addition of a care pathway may further improve appropriate antibiotic use.