Review of antibiotic use in respiratory disorders at a regional hospital in Queensland

Adherence to antibiotic guidelines has been shown to improve outcomes in several clinical situations. Respiratory conditions are a major cause of mortality and morbidity in Queensland. A recent study showed low levels of compliance with antibiotic guidelines in a Queensland metropolitan hospital. We undertook an audit of antibiotic use in a regional Queensland hospital against Therapeutic Guideline recommendations. Therapeutic Guideline recommendations were followed in 16% of cases with ceftriaxone the most commonly prescribed. Re-admission rate within 28 days was for 53%, 26%, 11% and 5% respectively for ceftriaxone, benzylpenicillin, amoxicillin/clavulanate and ceftriaxone combined doxycycline. Less than half of patients treated for pneumonia had concordant radiographic changes. Admission via the emergency department may be a factor in the preference for intravenous injection of ceftriaxone and presence of non-infective co-morbidities may also contribute to re-admissions. Considerable challenges exist in improving compliance with antibiotic guidelines which can improve patient outcomes and antibiotic stewardship.