Examining the impact of treatment guidelines on outpatient antibiotic prescription trends at a cancer center in Pakistan
Abbas, Salma Aslam, Seemal Batool, Sara Zafar, Mahnoor Khaliq, Sadia Fatima, Momal Shehzad, Iraj Arslan, Muhammad Attiq, Iqra Shehbaz, Muhammad
Abbas, Salma
Aslam, Seemal
Batool, Sara
Zafar, Mahnoor
Khaliq, Sadia
Fatima, Momal
Shehzad, Iraj
Arslan, Muhammad
Attiq, Iqra
Shehbaz, Muhammad
Affiliation
Shaukat Khanum Memorial Cancer Hospital and Research Center; University Hospitals Birmingham NHS Foundation Trust
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Publication date
2025-02-20
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Abstract
Objective: To assess the impact of treatment guidelines on the trends of outpatient antibiotic prescription among pediatric and adult patients at a cancer center in Pakistan.
Design: Retrospective observational study conducted between July 1st 2018 and July 31st 2023.
Methods: We determined the indication for antibiotics and the frequency of guideline-discordant prescriptions for upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), urinary tract infection (UTI), and diarrhea. The χ2 test was used to assess the impact of treatment guidelines on antibiotics prescribed for these indications.
Results: The top indications for antibiotic prescription were skin and skin structure infection (SSSI) (n = 5159; 21.5%), URTI (n = 2760; 11.5%) and UTI (n = 2686; 11.2%). Amoxicillin-clavulanate (n = 7964; 33.3%), was the most frequently prescribed antibiotic. A large proportion of antibiotic prescriptions for URTI, diarrhea, UTI, and LRTI were either inappropriate (n = 6695; 86.5%) or unnecessary (n = 5534; 71.5%). Results revealed a statistically significant decline in the proportion of inappropriate antibiotics for UTI (91.3% vs 84.0%; P ≤ .001) and diarrhea (92.6% vs 87.0%; P = .031) and unnecessary antibiotics for diarrhea (90.2% vs 83.2%; P = .016) with the introduction of treatment guidelines. We noted a higher proportion of unnecessary prescriptions for LRTI (41.7% vs 31.7%; P = .003) and inappropriate antibiotics for UTI (95.1% vs 87.4%; P = .011) for pediatric patients.
Conclusion: Misuse of outpatient antibiotics is common. Diarrhea, URTI, UTI, and LRTI are high-priority conditions for outpatient oncology-focused prescriber education and stewardship interventions.
Citation
Abbas S, Aslam S, Batool S, Zafar M, Khaliq S, Fatima M, Shehzad I, Arslan M, Attiq I, Shehbaz M, Khan A, Raza MA, Zulfiqar H, Mahmood A, Sultan F. Examining the impact of treatment guidelines on outpatient antibiotic prescription trends at a cancer center in Pakistan. Antimicrob Steward Healthc Epidemiol. 2025 Feb 20;5(1):e51. doi: 10.1017/ash.2025.2.
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Article