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JAC Advance Access published online on March 10, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl076
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Received November 11, 2005
Revised February 13, 2006
Accepted February 19, 2006

Brief report

Failure to implement hospital antimicrobial prescribing guidelines: a comparison of two UK academic centres

M. H. Ali 1, P. Kalima 2, and S. R. J. Maxwell 1 *

1 Clinical Pharmacology Unit, University of Edinburgh, Queen's Medical Research Institute, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4TJ, UK
2 Department of Medical Microbiology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK

* To whom correspondence should be addressed.
S. R. J. Maxwell, E-mail: s.maxwell{at}ed.ac.uk


  Abstract

Background: Rational antimicrobial therapy should provide maximum benefit to patients while minimizing the development of resistant microorganisms.

Objectives: The aim of this study was to investigate (i) which antimicrobial drugs were chosen by hospital doctors faced with two common infections [community-acquired pneumonia (CAP) and urinary tract infection (UTI)], (ii) whether these choices were compliant with local guidance and (iii) the factors that influenced antimicrobial choice.

Methods: A questionnaire based on two hypothetical clinical scenarios was distributed to 316 hospital doctors across four UK NHS hospitals in two cities (Newcastle and Edinburgh).

Results: Doctors in Newcastle were significantly more aggressive in their management: more patients were admitted (CAP: 78.9% versus 48.4%, P < 0.05) and given antimicrobials intravenously (CAP: 53.4% versus 21.2%, P < 0.05). Adherence to the local hospital guideline for CAP was significantly higher in Newcastle (83.3% versus 38.0%; P < 0.05). Fewer than half of the doctors surveyed used the local hospital guideline when choosing an antimicrobial, and the British National Formulary was the most frequently used resource (>90%). Junior doctors also identified medical school teaching and opinions of senior doctors as important influences.

Conclusions: This study highlights inadequacies in the implementation and promotion of local guidelines, and demonstrates the potential for widely varying antimicrobial practices in two comparable UK cities.

Keywords: junior doctors; medical education; formulary.
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