Multiple antibiotic changes during the first 72 hours of hospitalization

Background: Increasing concern about inappropriate antibiotic use prompted us to examine whether our patients were receiving frequent and perhaps unwa rranted changes of antibiotic therapy. Methods: We evaluated antibiotic pre scribing by the physicians in the Emergency Department and by those on the inpatient medical service during the first 72 hours of hospitalization in 1 19 patients admitted with suspected serious infections to an acute care, un iversity-affiliated, municipal teaching hospital. The appropriateness of an tibiotic prescriptions was assessed independently and retrospectively by 2 infectious disease specialists (each based at a different hospital) using a 4-grade scale (from 1 = wrong choice to 4 = appropriate). Of their evaluat ions of the 427 antibiotic regimens given to the 119 patients during 4 defi ned intervals during their first 72 hours of hospitalization, 90% agreed wi th each other within 1 grade. Their evaluations were then compared with the selections that had been made at each interval by the prescribing physicia ns. Results: Successive prescribing physicians changed the antibiotic regim ens in 77% of cases during the first 24 hours and in 56% during the next 48 , often without apparent clinical or microbiologic indications. By 72 hours , the 119 patients had received a mean of 3.1 +/- 1.3 (+/- SD) different an tibiotics, and 40 received between 4 and 7. Only 7% of the patients had no change in the regimen prescribed originally. Conclusions: Many patients had multiple changes of antibiotics, often unnecessarily, resulting in exposur e to too many agents.