Prescription of oral antibiotics and its appropriateness for outpatients in a tertiary care hospital in Korea

Abstract

Objectives: Antimicrobial stewardship programmes (ASPs) have gained prominence, with increased awareness regarding the importance of appropriate antibiotic use. However, ASP implementation for outpatient antibiotic prescription is uncommon, particularly in South Korea. This study aimed to analyse the patterns and appropriateness of outpatient antibiotic prescription at a tertiary care hospital in Korea.

Methods: This study analysed the patterns of oral antibiotic prescription between 1^st June 2018 and 31^st May 2023 at the outpatient department of Seoul National University Bundang Hospital. The appropriateness of prescriptions issued between 15^th and 19^th May 2023 was assessed. The assessment criteria included: indication for antibiotic use; antibiotic choice; duration; and dose/frequency. Pharmacists and infectious diseases specialists performed evaluations.

Results: In total, 7,282,407 outpatient visits were recorded over the 5-year study period, and oral antibiotics were prescribed in 243,967 (3.4%) cases. The frequency of antibiotic prescription was highest in dentistry, dermatology and urology departments. The most commonly prescribed antibiotics were cephalosporins, penicillins and sulphonamides. Of the 423 prescriptions evaluated, 289 (68.3%) and 134 (31.7%) were for treatment and prophylaxis, respectively. Prescriptions were classified as inappropriate in 28.4% (82/289) and 70.9% (95/134) of treatment and prophylaxis cases, respectively. The primary reason for inappropriateness in both treatment and prophylaxis cases was inappropriate indication, accounting for 46.3% (38/82) of treatment prescriptions and 96.8% (92/95) of prophylaxis prescriptions.

Conclusions: Antibiotics were prescribed at 3.4% of all outpatient visits. The prescription was inappropriate in 28.4% of treatment cases and 70.9% of prophylactic cases. Proactive and expansive ASP activities by pharmacists should be considered in outpatient settings.

Keywords: Antimicrobial stewardship programme; Appropriate assessment; Outpatient.