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Are we prescribing antibiotics correctly An Audit of Ciprofloxacin Prescription in the Urology department of Harrogate

Background. Ciprofloxacin is an effective broad spectrum antibiotic with good penetration and activity against gram negative bacteria, particularly Pseudomonas.Ciprofloxacin use is associated with an increased incidence of MRSA and Clostridium Difficile infectionsHarrogate Hospital limits the use of Ciprofloxacin, but use is unrestricted for UrologyUrological Ciprofloxacin prescription should therefore be conscientiousAimTo audit if Ciprofloxacin is being prescribed appropriately, in relation to: clinical indication, sensitivities and course length.

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Are we prescribing antibiotics correctly An Audit of Ciprofloxacin Prescription in the Urology department of Harrogate

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    1. Are we prescribing antibiotics correctly? An Audit of Ciprofloxacin Prescription in the Urology department of Harrogate Hospital Dr Sarah Eccles , FY1, Harrogate Hospital Dr Jenna Ward, RMO 1, Gosford and Wyong Hospital Miss Anne-Marie Davies, Consultant Urologist, Harrogate Hospital

    2. Background Ciprofloxacin is an effective broad spectrum antibiotic with good penetration and activity against gram negative bacteria, particularly Pseudomonas. Ciprofloxacin use is associated with an increased incidence of MRSA and Clostridium Difficile infections Harrogate Hospital limits the use of Ciprofloxacin, but use is unrestricted for Urology Urological Ciprofloxacin prescription should therefore be conscientious Aim To audit if Ciprofloxacin is being prescribed appropriately, in relation to: clinical indication, sensitivities and course length

    3. Method Audited against guidelines from Urology handbook and Harrogate prescribing formulary: UTI: Trimethoprim 1st line, Ciprofloxacin 2nd line Epidydimorchitis: <35 yrs Doxycycline 1st line, >35 yrs as per culture or Ciprofloxacin 1st line Pyelonephritis: Amoxicillin and Gentamicin 1st line, Ciprofloxacin 2nd line Prostatitis: Ciprofloxacin 1st line Sample All inpatient urology admissions within a three month period (n= 295) Discharge summaries and drug charts checked for Ciprofloxacin use (n=48) Case note examination for: indication and confirmation of infection Drug chart and discharge summaries examined for: course documentation and duration

    4. Prescription Indications Appropriate vs. Inappropriate

    5. Culture and Sensitivities

    6. Course Length Range and Averages Course Length Documentation

    7. Why is this all so important? A Case of RL – a patient in the sample Admitted for procedure to remove nephrostomy and change ureteric stent Prescribed Ciprofloxacin post op based on dysuria and pyrexia, received 5 day course Urine sample grew bacteria resistant to Ciprofloxacin, sensitive to Amoxicillin. Antibiotics were not changed despite sensitivities. Patient developed C. Diff Considerably lengthened hospital stay Patient suffered with symptoms of severe diarrhoea and lethargy/malaise

    8. Conclusion Study Limitations: Sample size Sampling difficulties Limited data collection detail per case Limited documentation Subjectivity of ‘appropriate’ Lack of definitive guidelines Case discussion with experts re. appropriate vs. inappropriate Ciprofloxacin prescribing guidelines need to be tightened Thought needs to be given as to appropriateness of antibiotic prescribed Length of course needs to be documented, and treatment changed according to sensitivities How do we change antibiotic prescribing practices?* *Interventions to improve antibiotic prescribing practice for hospital inpatients (Review), Cochrane Collaboration 2005

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