An audit of antimicrobial treatment of lower respiratory and urinary tract infections in a hospital setting

H. Maripuu, M.A. Aldeyab, M.P. Kearney, J.C. McElnay, G. Conlon, F.A. Magee, M.G. Scott

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives To audit the quality of treatment of lower respiratory tract infections (LRTIs) and urinary tract infections (UTIs) and to identify targets for antibiotic stewardship. Methods The audit involved collecting data on admitted patients, who were diagnosed with LRTIs or UTIs and subsequently received antibiotic treatment (January 2009-April 2009). Key findings The percentage adherence rate for hospital antibiotic policy was 68.6% (24/35). Documentation of the CURB-65 score was found in 80% (16/20) of the patients' clinical notes, for which 46.2% (6/13) of patients were treated according to their CURB- 65 score. The percentages of delayed and missed doses for all antibiotics were 21.7% (254/1171) and 8.6% (101/1171), respectively. The percentage of patients switched from intravenous to oral antibiotics in accordance with the policy was 58.5% (31/53). The mean length of stay for patients switched in line with the guidelines was 6.9 days (range: 2-18 days) compared with 13.2 days (range: 4-28 days) for patients treated with intravenous antibiotics >24 h after the intravenous to oral switch criteria were fulfilled; this equates to on average an extra 6.3 days of hospitalisation (p=0.01). Conclusions The study identified a number of targets for quality improvement including adherence to antibiotic policy, documentation of the CURB-65 score in patients' notes and treating patients accordingly, addressing the issue of missed and delayed doses, and maintaining adherence to the hospital intravenous-to-oral antibiotic switch policy. The findings suggest that the quality of antibiotic prescribing could be improved by measuring and addressing such performance indicators.
LanguageEnglish
Pages139-144
Number of pages6
JournalEuropean Journal of Hospital Pharmacy
Volume21
Issue number3
DOIs
Publication statusPublished - 2014

Fingerprint

Urinary Tract Infections
Respiratory Tract Infections
Anti-Bacterial Agents
Therapeutics
Documentation
Quality Improvement
Length of Stay
Hospitalization
Guidelines

Keywords

  • amoxicillin
  • amoxicillin plus clavulanic acid
  • aztreonam
  • clarithromycin
  • doxycycline
  • gentamicin
  • metronidazole
  • piperacillin plus tazobactam
  • teicoplanin
  • antiinfective agent
  • adolescent
  • adult
  • aged
  • antimicrobial therapy
  • article
  • aspiration pneumonia
  • chronic obstructive lung disease
  • community acquired pneumonia
  • CURB 65 Score
  • female
  • health care policy
  • hospital acquired pneumonia
  • hospital management
  • hospitalization
  • human
  • lower respiratory tract infection
  • major clinical study
  • male
  • medical audit
  • prospective study
  • quality control
  • scoring system
  • sepsis
  • teaching hospital
  • United Kingdom
  • urinary tract infection
  • Article
  • assessment of humans
  • clinical practice
  • coronary artery disease
  • CURB 65
  • drug administration route
  • health care cost
  • length of stay
  • middle aged
  • mortality
  • protocol compliance
  • respiratory tract infection
  • young adult

Cite this

Maripuu, H., Aldeyab, M. A., Kearney, M. P., McElnay, J. C., Conlon, G., Magee, F. A., & Scott, M. G. (2014). An audit of antimicrobial treatment of lower respiratory and urinary tract infections in a hospital setting. European Journal of Hospital Pharmacy, 21(3), 139-144. https://doi.org/10.1136/ejhpharm-2013-000394
Maripuu, H. ; Aldeyab, M.A. ; Kearney, M.P. ; McElnay, J.C. ; Conlon, G. ; Magee, F.A. ; Scott, M.G. / An audit of antimicrobial treatment of lower respiratory and urinary tract infections in a hospital setting. In: European Journal of Hospital Pharmacy. 2014 ; Vol. 21, No. 3. pp. 139-144.
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abstract = "Objectives To audit the quality of treatment of lower respiratory tract infections (LRTIs) and urinary tract infections (UTIs) and to identify targets for antibiotic stewardship. Methods The audit involved collecting data on admitted patients, who were diagnosed with LRTIs or UTIs and subsequently received antibiotic treatment (January 2009-April 2009). Key findings The percentage adherence rate for hospital antibiotic policy was 68.6{\%} (24/35). Documentation of the CURB-65 score was found in 80{\%} (16/20) of the patients' clinical notes, for which 46.2{\%} (6/13) of patients were treated according to their CURB- 65 score. The percentages of delayed and missed doses for all antibiotics were 21.7{\%} (254/1171) and 8.6{\%} (101/1171), respectively. The percentage of patients switched from intravenous to oral antibiotics in accordance with the policy was 58.5{\%} (31/53). The mean length of stay for patients switched in line with the guidelines was 6.9 days (range: 2-18 days) compared with 13.2 days (range: 4-28 days) for patients treated with intravenous antibiotics >24 h after the intravenous to oral switch criteria were fulfilled; this equates to on average an extra 6.3 days of hospitalisation (p=0.01). Conclusions The study identified a number of targets for quality improvement including adherence to antibiotic policy, documentation of the CURB-65 score in patients' notes and treating patients accordingly, addressing the issue of missed and delayed doses, and maintaining adherence to the hospital intravenous-to-oral antibiotic switch policy. The findings suggest that the quality of antibiotic prescribing could be improved by measuring and addressing such performance indicators.",
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author = "H. Maripuu and M.A. Aldeyab and M.P. Kearney and J.C. McElnay and G. Conlon and F.A. Magee and M.G. Scott",
note = "Cited By :4 Export Date: 15 September 2018 Correspondence Address: Scott, M. G.; Head of Pharmacy and Medicines Management, Pharmacy and Medicines Management Centre, Antrim Area Hospital, 45 Bush Road, Antrim BT41 2RL, United Kingdom; email: DrMichael.Scott@northerntrust.hscni.net Chemicals/CAS: amoxicillin, 26787-78-0, 34642-77-8, 61336-70-7; amoxicillin plus clavulanic acid, 74469-00-4, 79198-29-1; aztreonam, 78110-38-0; clarithromycin, 81103-11-9; doxycycline, 10592-13-9, 17086-28-1, 564-25-0, 94088-85-4; gentamicin, 1392-48-9, 1403-66-3, 1405-41-0; metronidazole, 39322-38-8, 443-48-1; teicoplanin, 61036-62-2, 61036-64-4 References: Tacconelli, E., Antimicrobial use: Risk driver of multidrug resistant microorganisms in healthcare settings (2009) Curr Opin Infect Dis, 22, pp. 352-358; Goff, D.A., Antimicrobial stewardship: Bridging the gap between quality care and cost (2011) Curr Opin Infect Dis, 24 (SUPPL. 1), pp. S11-S20; Wilcox, M.H., Dave, J., The cost of hospital-acquired infection and the value of infection control (2000) J Hosp Infect, 45, pp. 81-84; Gyssens, I.C., Quality measures of antimicrobial drug use (2001) Int J Antimicrob Agents, 17, pp. 9-19; Hecker, M.T., Aron, D.C., Patel, N.P., Unnecessary use of antimicrobials in hospitalized patients: Current patterns of misuse with an emphasis on the anti-anaerobic spectrum of activity (2003) Arch Intern Med, 163, pp. 972-978; Paterson, D.L., The role of antimicrobial management programs in optimizing antibiotic prescribing within hospitals (2006) Clin Infect Dis, 42 (SUPPL. 2), pp. S90-S95; Gould, I.M., Antibiotic policies to control hospital-acquired infection (2008) J Antimicrob Chemother, 61, pp. 763-765; Dellit, T.H., Owens, R.C., McGowan Jr., J.E., Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship (2007) Clin Infect Dis, 44, pp. 159-177; Ohl, C.A., Luther, V.P., Antimicrobial stewardship for inpatient facilities (2011) J Hosp Med, 6 (SUPPL. 1), pp. S4-S15; Davey, P., Brown, E., Charani, E., Interventions to improve antibiotic prescribing practices for hospitalised inpatients (Review) (2013) Cochrane Database Syst Rev, 4, pp. CD003543; Lesprit, P., Brun-Buisson, C., Hospital antibiotic stewardship (2008) Curr Opin Infect Dis, 21, pp. 344-349; Desai, M., Franklin, B.D., Holmes, A.H., A new approach to treatment of resistant gram-positive infections: Potential impact of targeted IV to oral switch on length of stay (2006) BMC Infect Dis, 8, p. 94; Athanassa, Z., Makris, G., Dimopoulos, G., Early switch to oral treatment in patients with moderate to severe community-acquired pneumonia: A meta-analysis (2008) Drugs, 68, pp. 2469-2481; Waagsb{\o}, B., Sund{\o}y, A., Paulsen, E.Q., Reduction of unnecessary i.v. antibiotic days using general criteria for antibiotic switch (2008) Scand J Infect Dis, 40, pp. 468-473; Lim, W.S., van der Eerden, M.M., Laing, R., Defining community acquired pneumonia severity on presentation to hospital: An international derivation and validation study (2003) Thorax, 58, pp. 377-382; Lim, S., Baudouin, S.V., Hill, A.T., BTS Guidelines for the management of community acquired pneumonia in adults: Update 2009 (2009) Thorax, 64 (SUPPL. 3), pp. 1-55; Sarmah, A.K., Meyer, M.T., Boxall, A.B.A., A global perspective on the use, sales, exposure pathways, occurrence, fate and effects of vetinary antibiotics (VAs) in the environment (2006) Chemosphere, 65, pp. 725-759; Castanon, J.I.R., History of the use of antibiotic as growth promoters in European Poultry Feeds (2007) Poultry Sci, 86, pp. 2466-2471; Ali, M.H., Kalima, P., Maxwell, S.R., Failure to implement hospital antimicrobial prescribing guidelines: A comparison of two UK academic centres (2006) J Antimicrob Chemother, 57, pp. 959-962; Aldeyab, M.A., Elshibly, S.M., McElnay, J.C., An evaluation of compliance with an antibiotic policy in surgical wards at a general teaching hospital in Northern Ireland (2009) Infect Control Hosp Epidemiol, 30, pp. 921-922; Macdougall, C., Polk, R.E., Antimicrobial stewardship programs in health care systems (2005) Clin Microbiol Rev, 18, pp. 638-656; Giblin, T.B., Sinkowitz-Cochran, R.L., Harris, P.L., Clinicians' perceptions of the problem of antimicrobial resistance in health care facilities (2004) Arch Intern Med, 164, pp. 1662-1668; Wester, C.W., Durairaj, L., Evans, A.T., Antibiotic resistance: A survey of physician perceptions (2002) Arch Intern Med, 162, pp. 2210-2216; Metlay, J.P., Shea, J.A., Crossette, L.B., Tensions in antibiotic prescribing: Pitting social concerns against the interests of individual patients (2002) J Gen Intern Med, 17, pp. 87-94; Aldeyab, M.A., Devine, M.J., Flanagan, P., Multi-hospital outbreak of Clostridium difficile ribotype 027 infection: Epidemiology and analysis of control measures (2011) Infect Control Hosp Epidemiol, 32, pp. 210-219; Aldeyab, M.A., Monnet, D.L., L{\'o}pez-Lozano, J.M., Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: A time-series analysis (2008) J Antimicrob Chemother, 62, pp. 593-600; Aldeyab, M.A., Harbarth, S., Vernaz, N., Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients (2009) Antimicrob Agents Chemother, 53, pp. 2082-2088; Bodasing, N., Cahill, S., Seaton, R.A., Survey of antimicrobial prescribing in West Glasgow hospitals (2002) J Infect, 44, p. 113; Laing, R.B., Mackenzie, A.R., Shaw, H., The effect of intravenous-to-oral switch guidelines on the use of parenteral antimicrobials in medical wards (1998) J Antimicrob Chemother, 42, pp. 107-111; Sevin{\cc}, F., Prins, J.M., Koopmans, R.P., Early switch from intravenous to oral antibiotics: Guidelines and implementation in a large teaching hospital (1999) J Antimicrob Chemother, 43, pp. 601-606; von Gunten, V., Amos, V., Sidler, A.L., Hospital pharmacists' reinforcement of guidelines for switching from parenteral to oral antibiotics: A pilot study (2003) Pharm World Sci, 25, pp. 52-55; Al-Eidan, F.A., McElnay, J.C., Scott, M.G., Sequential antimicrobial therapy: Treatment of severe lower respiratory tract infections in children (1999) J Antimicrob Chemother, 44, pp. 709-715; Al-Eidan, F.A., McElnay, J.C., Scott, M.G., Use of a treatment protocol in the management of community-acquired lower respiratory tract infection (2000) J Antimicrob Chemother, 45, pp. 387-394; Aldeyab, M.A., Kearney, M.P., McElnay, J.C., A point prevalence survey of antibiotic prescriptions: Benchmarking and patterns of use (2010) Br J Clin Pharmacol, 71, pp. 293-296",
year = "2014",
doi = "10.1136/ejhpharm-2013-000394",
language = "English",
volume = "21",
pages = "139--144",
journal = "European Journal of Hospital Pharmacy",
issn = "2047-9956",
number = "3",

}

An audit of antimicrobial treatment of lower respiratory and urinary tract infections in a hospital setting. / Maripuu, H.; Aldeyab, M.A.; Kearney, M.P.; McElnay, J.C.; Conlon, G.; Magee, F.A.; Scott, M.G.

In: European Journal of Hospital Pharmacy, Vol. 21, No. 3, 2014, p. 139-144.

Research output: Contribution to journalArticle

TY - JOUR

T1 - An audit of antimicrobial treatment of lower respiratory and urinary tract infections in a hospital setting

AU - Maripuu, H.

AU - Aldeyab, M.A.

AU - Kearney, M.P.

AU - McElnay, J.C.

AU - Conlon, G.

AU - Magee, F.A.

AU - Scott, M.G.

N1 - Cited By :4 Export Date: 15 September 2018 Correspondence Address: Scott, M. G.; Head of Pharmacy and Medicines Management, Pharmacy and Medicines Management Centre, Antrim Area Hospital, 45 Bush Road, Antrim BT41 2RL, United Kingdom; email: DrMichael.Scott@northerntrust.hscni.net Chemicals/CAS: amoxicillin, 26787-78-0, 34642-77-8, 61336-70-7; amoxicillin plus clavulanic acid, 74469-00-4, 79198-29-1; aztreonam, 78110-38-0; clarithromycin, 81103-11-9; doxycycline, 10592-13-9, 17086-28-1, 564-25-0, 94088-85-4; gentamicin, 1392-48-9, 1403-66-3, 1405-41-0; metronidazole, 39322-38-8, 443-48-1; teicoplanin, 61036-62-2, 61036-64-4 References: Tacconelli, E., Antimicrobial use: Risk driver of multidrug resistant microorganisms in healthcare settings (2009) Curr Opin Infect Dis, 22, pp. 352-358; Goff, D.A., Antimicrobial stewardship: Bridging the gap between quality care and cost (2011) Curr Opin Infect Dis, 24 (SUPPL. 1), pp. S11-S20; Wilcox, M.H., Dave, J., The cost of hospital-acquired infection and the value of infection control (2000) J Hosp Infect, 45, pp. 81-84; Gyssens, I.C., Quality measures of antimicrobial drug use (2001) Int J Antimicrob Agents, 17, pp. 9-19; Hecker, M.T., Aron, D.C., Patel, N.P., Unnecessary use of antimicrobials in hospitalized patients: Current patterns of misuse with an emphasis on the anti-anaerobic spectrum of activity (2003) Arch Intern Med, 163, pp. 972-978; Paterson, D.L., The role of antimicrobial management programs in optimizing antibiotic prescribing within hospitals (2006) Clin Infect Dis, 42 (SUPPL. 2), pp. S90-S95; Gould, I.M., Antibiotic policies to control hospital-acquired infection (2008) J Antimicrob Chemother, 61, pp. 763-765; Dellit, T.H., Owens, R.C., McGowan Jr., J.E., Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship (2007) Clin Infect Dis, 44, pp. 159-177; Ohl, C.A., Luther, V.P., Antimicrobial stewardship for inpatient facilities (2011) J Hosp Med, 6 (SUPPL. 1), pp. S4-S15; Davey, P., Brown, E., Charani, E., Interventions to improve antibiotic prescribing practices for hospitalised inpatients (Review) (2013) Cochrane Database Syst Rev, 4, pp. CD003543; Lesprit, P., Brun-Buisson, C., Hospital antibiotic stewardship (2008) Curr Opin Infect Dis, 21, pp. 344-349; Desai, M., Franklin, B.D., Holmes, A.H., A new approach to treatment of resistant gram-positive infections: Potential impact of targeted IV to oral switch on length of stay (2006) BMC Infect Dis, 8, p. 94; Athanassa, Z., Makris, G., Dimopoulos, G., Early switch to oral treatment in patients with moderate to severe community-acquired pneumonia: A meta-analysis (2008) Drugs, 68, pp. 2469-2481; Waagsbø, B., Sundøy, A., Paulsen, E.Q., Reduction of unnecessary i.v. antibiotic days using general criteria for antibiotic switch (2008) Scand J Infect Dis, 40, pp. 468-473; Lim, W.S., van der Eerden, M.M., Laing, R., Defining community acquired pneumonia severity on presentation to hospital: An international derivation and validation study (2003) Thorax, 58, pp. 377-382; Lim, S., Baudouin, S.V., Hill, A.T., BTS Guidelines for the management of community acquired pneumonia in adults: Update 2009 (2009) Thorax, 64 (SUPPL. 3), pp. 1-55; Sarmah, A.K., Meyer, M.T., Boxall, A.B.A., A global perspective on the use, sales, exposure pathways, occurrence, fate and effects of vetinary antibiotics (VAs) in the environment (2006) Chemosphere, 65, pp. 725-759; Castanon, J.I.R., History of the use of antibiotic as growth promoters in European Poultry Feeds (2007) Poultry Sci, 86, pp. 2466-2471; Ali, M.H., Kalima, P., Maxwell, S.R., Failure to implement hospital antimicrobial prescribing guidelines: A comparison of two UK academic centres (2006) J Antimicrob Chemother, 57, pp. 959-962; Aldeyab, M.A., Elshibly, S.M., McElnay, J.C., An evaluation of compliance with an antibiotic policy in surgical wards at a general teaching hospital in Northern Ireland (2009) Infect Control Hosp Epidemiol, 30, pp. 921-922; Macdougall, C., Polk, R.E., Antimicrobial stewardship programs in health care systems (2005) Clin Microbiol Rev, 18, pp. 638-656; Giblin, T.B., Sinkowitz-Cochran, R.L., Harris, P.L., Clinicians' perceptions of the problem of antimicrobial resistance in health care facilities (2004) Arch Intern Med, 164, pp. 1662-1668; Wester, C.W., Durairaj, L., Evans, A.T., Antibiotic resistance: A survey of physician perceptions (2002) Arch Intern Med, 162, pp. 2210-2216; Metlay, J.P., Shea, J.A., Crossette, L.B., Tensions in antibiotic prescribing: Pitting social concerns against the interests of individual patients (2002) J Gen Intern Med, 17, pp. 87-94; Aldeyab, M.A., Devine, M.J., Flanagan, P., Multi-hospital outbreak of Clostridium difficile ribotype 027 infection: Epidemiology and analysis of control measures (2011) Infect Control Hosp Epidemiol, 32, pp. 210-219; Aldeyab, M.A., Monnet, D.L., López-Lozano, J.M., Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: A time-series analysis (2008) J Antimicrob Chemother, 62, pp. 593-600; Aldeyab, M.A., Harbarth, S., Vernaz, N., Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients (2009) Antimicrob Agents Chemother, 53, pp. 2082-2088; Bodasing, N., Cahill, S., Seaton, R.A., Survey of antimicrobial prescribing in West Glasgow hospitals (2002) J Infect, 44, p. 113; Laing, R.B., Mackenzie, A.R., Shaw, H., The effect of intravenous-to-oral switch guidelines on the use of parenteral antimicrobials in medical wards (1998) J Antimicrob Chemother, 42, pp. 107-111; Sevinç, F., Prins, J.M., Koopmans, R.P., Early switch from intravenous to oral antibiotics: Guidelines and implementation in a large teaching hospital (1999) J Antimicrob Chemother, 43, pp. 601-606; von Gunten, V., Amos, V., Sidler, A.L., Hospital pharmacists' reinforcement of guidelines for switching from parenteral to oral antibiotics: A pilot study (2003) Pharm World Sci, 25, pp. 52-55; Al-Eidan, F.A., McElnay, J.C., Scott, M.G., Sequential antimicrobial therapy: Treatment of severe lower respiratory tract infections in children (1999) J Antimicrob Chemother, 44, pp. 709-715; Al-Eidan, F.A., McElnay, J.C., Scott, M.G., Use of a treatment protocol in the management of community-acquired lower respiratory tract infection (2000) J Antimicrob Chemother, 45, pp. 387-394; Aldeyab, M.A., Kearney, M.P., McElnay, J.C., A point prevalence survey of antibiotic prescriptions: Benchmarking and patterns of use (2010) Br J Clin Pharmacol, 71, pp. 293-296

PY - 2014

Y1 - 2014

N2 - Objectives To audit the quality of treatment of lower respiratory tract infections (LRTIs) and urinary tract infections (UTIs) and to identify targets for antibiotic stewardship. Methods The audit involved collecting data on admitted patients, who were diagnosed with LRTIs or UTIs and subsequently received antibiotic treatment (January 2009-April 2009). Key findings The percentage adherence rate for hospital antibiotic policy was 68.6% (24/35). Documentation of the CURB-65 score was found in 80% (16/20) of the patients' clinical notes, for which 46.2% (6/13) of patients were treated according to their CURB- 65 score. The percentages of delayed and missed doses for all antibiotics were 21.7% (254/1171) and 8.6% (101/1171), respectively. The percentage of patients switched from intravenous to oral antibiotics in accordance with the policy was 58.5% (31/53). The mean length of stay for patients switched in line with the guidelines was 6.9 days (range: 2-18 days) compared with 13.2 days (range: 4-28 days) for patients treated with intravenous antibiotics >24 h after the intravenous to oral switch criteria were fulfilled; this equates to on average an extra 6.3 days of hospitalisation (p=0.01). Conclusions The study identified a number of targets for quality improvement including adherence to antibiotic policy, documentation of the CURB-65 score in patients' notes and treating patients accordingly, addressing the issue of missed and delayed doses, and maintaining adherence to the hospital intravenous-to-oral antibiotic switch policy. The findings suggest that the quality of antibiotic prescribing could be improved by measuring and addressing such performance indicators.

AB - Objectives To audit the quality of treatment of lower respiratory tract infections (LRTIs) and urinary tract infections (UTIs) and to identify targets for antibiotic stewardship. Methods The audit involved collecting data on admitted patients, who were diagnosed with LRTIs or UTIs and subsequently received antibiotic treatment (January 2009-April 2009). Key findings The percentage adherence rate for hospital antibiotic policy was 68.6% (24/35). Documentation of the CURB-65 score was found in 80% (16/20) of the patients' clinical notes, for which 46.2% (6/13) of patients were treated according to their CURB- 65 score. The percentages of delayed and missed doses for all antibiotics were 21.7% (254/1171) and 8.6% (101/1171), respectively. The percentage of patients switched from intravenous to oral antibiotics in accordance with the policy was 58.5% (31/53). The mean length of stay for patients switched in line with the guidelines was 6.9 days (range: 2-18 days) compared with 13.2 days (range: 4-28 days) for patients treated with intravenous antibiotics >24 h after the intravenous to oral switch criteria were fulfilled; this equates to on average an extra 6.3 days of hospitalisation (p=0.01). Conclusions The study identified a number of targets for quality improvement including adherence to antibiotic policy, documentation of the CURB-65 score in patients' notes and treating patients accordingly, addressing the issue of missed and delayed doses, and maintaining adherence to the hospital intravenous-to-oral antibiotic switch policy. The findings suggest that the quality of antibiotic prescribing could be improved by measuring and addressing such performance indicators.

KW - amoxicillin

KW - amoxicillin plus clavulanic acid

KW - aztreonam

KW - clarithromycin

KW - doxycycline

KW - gentamicin

KW - metronidazole

KW - piperacillin plus tazobactam

KW - teicoplanin

KW - antiinfective agent

KW - adolescent

KW - adult

KW - aged

KW - antimicrobial therapy

KW - article

KW - aspiration pneumonia

KW - chronic obstructive lung disease

KW - community acquired pneumonia

KW - CURB 65 Score

KW - female

KW - health care policy

KW - hospital acquired pneumonia

KW - hospital management

KW - hospitalization

KW - human

KW - lower respiratory tract infection

KW - major clinical study

KW - male

KW - medical audit

KW - prospective study

KW - quality control

KW - scoring system

KW - sepsis

KW - teaching hospital

KW - United Kingdom

KW - urinary tract infection

KW - Article

KW - assessment of humans

KW - clinical practice

KW - coronary artery disease

KW - CURB 65

KW - drug administration route

KW - health care cost

KW - length of stay

KW - middle aged

KW - mortality

KW - protocol compliance

KW - respiratory tract infection

KW - young adult

U2 - 10.1136/ejhpharm-2013-000394

DO - 10.1136/ejhpharm-2013-000394

M3 - Article

VL - 21

SP - 139

EP - 144

JO - European Journal of Hospital Pharmacy

T2 - European Journal of Hospital Pharmacy

JF - European Journal of Hospital Pharmacy

SN - 2047-9956

IS - 3

ER -