Antibiotic Prescribing Practices in Paediatric Hospital-At-Home Care Model A Retrospective Cohort Study

Abstract

Background: Paediatric patients at the Royal London Hospital referred to the Hospital-At-Home service mostly receive intravenous antibiotic therapy. However, prescribing practices and the appropriateness of the chosen antibiotics have not been evaluated before. This study evaluated the appropriateness of antibiotics prescribed for those patients.

Methods: Patients referred to HAH between 01 August 2023 and 31 January 2024 were screened using a retrospective cohort design. Descriptive analysis was used to analyse the collected data which included biomarkers trends, bio-samples cultured, and evidence of a multi-professional team collaboration.

Results: Most patients were neonates aged 28 days or under, 50%. The most common presenting complaint was suspected sepsis (50%). The working diagnosis remained suspected sepsis for 28% of patients while confirmed sepsis in 19%. Also, 17% of patients were diagnosed with viral infections. 79% of participants were reviewed by a clinician before HAH referral, and the advice of an ID consultant was sought by 16%. There was 88% adherence to prescribing guidelines. Only 4.3% of patients were switched to oral antibiotics; however, the switch suitability evaluation suggested that 27.3% of patients were suitable for the switch. Furthermore, the ID consultant recommended stopping or switching to an oral antibiotic for 15% of the chosen patients and potentially discontinuing for 74%.

Conclusion: Improvements in antibiotic prescribing practices can be achieved by implementing a robust antimicrobial stewardship program. The active engagement of a multidisciplinary team, comprising a paediatric ID consultant, and pharmacist specialist, is vital in achieving these improvements.