Article Text
Abstract
Objective To evaluate quality and variation in antibiotic prescribing for neonatal sepsis.
Design We analysed prescribing in hospitalised neonates using the National Antimicrobial Prescribing Survey in Australian neonates from 1 January 2014 to 31 December 2018.
Setting Data from antibiotic point prevalence surveys performed in hospitals, ranging from rural hospitals to tertiary paediatric and maternity hospitals within Australia.
Patients Admitted neonates <28 days of age from participating hospitals.
Main outcome measures Variation and appropriateness in prescribing for neonatal sepsis and variation in dosing for gentamicin and benzylpenicillin across hospitals.
Results A total of 415 prescriptions among 214 neonates from 39 different hospitals were included. The majority of prescriptions (342, 82.4%) were for neonates <7 days of age. The most commonly prescribed antibiotics were gentamicin and benzylpenicillin, with 323 (77.8%) prescriptions. Dosing variability was substantial, with doses ranging from 2 to 8 mg/kg for gentamicin (median 5 mg/kg, IQR 4–5) and from 45 to 72 mg/kg for benzylpenicillin (median 60 mg/kg, IQR 50–60), although only 13 (3.2%) and 19 (4.6%) prescriptions were locally assessed as inappropriate or non-compliant with guidelines, respectively. At time of audit, 22% of antibiotics had been given for more than 48 hours and 9% more than 72 hours, although microbiologically confirmed infection was documented in only nine (4.2%) neonates.
Conclusions Prescribing for neonatal sepsis was dominated by use of benzylpenicillin and gentamicin with substantial variation in dosing. A small minority had culture-confirmed infection. Efforts to standardise antibiotic dosing and duration for suspected neonatal sepsis are recommended.
- epidemiology
- infectious diseases
- neonatology
- therapeutics
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Footnotes
Contributors BM planned, conducted, analysed, wrote, revised and submitted the study. CC, NS, RJ, CJ, PK and CB analysed, cowrote and revised the study. TK planned, analysed, cowrote and revised the study.
Funding This work was supported by a PhD scholarship from the University of Melbourne for BM. Since 2013 the Australian Commission on Safety and Quality in Health Care has supported the NAPS programme for the AURA Surveillance System. CB is supported by an NHMRC Career Development Fellowship (APP1111596). There was no direct funding for the preparation or revision of this manuscript. NS is supported by a PhD scholarship from the Australian Commonwealth Government.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethics approval as a quality assurance project was obtained from the Melbourne Health Human Research Ethics Committee to coordinate the NAPS (no QA2013066).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.