Antibiotic prescribing practices in public and private-sector intensive care units in South Africa

Introduction

Considerable variability exists in antibiotic prescribing practices. A dichotomous health care system in South Africa has created the opportunity for vastly differing practices. As part of a national 1-day sepsis prevalence study (PISA), a review was undertaken of antibiotic prescribing practices in public and private-sector ICUs.

Method

Following appropriate institutional approval, 43 ICUs were selected using the proportional probability sampling technique. This was applied to a national database of ICUs. Every seventh bed was selected from all the serially placed units. Antibiotic therapy was reviewed by two independent reviewers. Data collected included the appropriateness of pretherapy cultures, postculture modification of therapy, duration of therapy and, finally, impact of appropriate antibiotic choice on mortality.

Results

See Table 1. Public-sector practice is better with respect to pretherapy sampling and duration of treatment. Better modification of treatment occurs in the private sector.

Table 1 Appropriateness of antibiotic therapy

Overall mortality of both groups was 10/82 (12%) when antibiotic choice was appropriate compared with 28/90 (31%) (P < 0.05) when therapy was inappropriate.

Conclusion

There are significant differences in antibiotic prescribing practices when public and private sectors are compared. Appropriate early antibiotic prescriptions reduce mortality. Attention to education and systems that address prescribing practices is indicated.