How Common Is Inappropriate Antibiotic Prescribing? An Australian Study Sheds Light

Inappropriate use of azithromycin for community-acquired pneumonia (CAP) is common in Australian tertiary hospitals, according to new data presented at CHEST 2021. Most study participants did not meet criteria for empiric antibiotic therapy based on pneumonia severity score, and 10 participants with prolonged corrected QT intervals received azithromycin despite its tendency to prolong these intervals.

Guidelines for the empiric antibiotic treatment of CAP depend on severity of pneumonia at presentation. Furthermore, azithromycin may cause fatal cardiac arrhythmias caused by corrected QT (QTc) interval prolongation.

To assess the appropriateness of azithromycin prescription for in-patients with CAP at St George Hospital in New South Wales, the research team retrospectively analyzed severity scores at admission for 100 such patients who had been prescribed azithromycin between July and December 2019. They also analyzed QTc intervals recorded for the subgroup of 67 study participants who had documented echocardiograms (ECGs).

The researchers found that 64% of patients (64 of 100) were prescribed azithromycin without meeting the criteria for severe CAP, and 15% of study participants (10 of 67) who had documented ECGs were prescribed azithromycin despite their prolonged QTc intervals. 

“Our data suggest that a concerning incidence of patients were prescribed azithromycin either without evidence of having their QTc intervals screened or despite having prolonged QTc intervals,” the team noted.

In addition, 26% of patients were prescribed azithromycin for longer than the maximum recommended duration of 5 days. Azithromycin was administered for an average of 4.5 days in the 100 participants included in the study.

These findings led the research team to conclude that the implementation of additional protocols and programs to promote the appropriate prescription of azithromycin in their hospital was necessary to ensure patient safety, improve outcomes, and enhance antimicrobial stewardship.

—Ellen Kurek

Reference:

Qian S, Siu J, El-Hajj Hussein A, Zheng  Y. Use of azithromycin for community‑acquired pneumonia: a retrospective study in a tertiary Australian hospital. Paper presented at: CHEST 2021 Annual Meeting; October 17-20, 2021; Virtual