Dynamics of Antibiotic Prescription in Royal Hampshire County Hospital in November 2016: A Prospective Study

  • Kathrine Lee-A-Ping St. George's University, School of Medicine, Grenada, West Indies.
  • Kordo Saeed MB ChB MSc FRCPath, Consultant Microbiologist/ Hampshire Hospitals NHS Foundation Trust, Honorary Senior Lecturer/ University of Southampton, Royal Hampshire County Hospital, Romsey Road, Winchester, United Kingdom.
  • Matthew Dryden MD FRCPath FRCPS (Glasgow), Consultant and Hon Senior Lecturer, Department of Microbiology and Infection, Hampshire Hospitals NHS Foundation Trust & Rare and Imported Pathogens Department, PHE, Porton. University of Southampton and Professor, Dept of Medicine, St Georges University, Grenada.
  • Gavin Sim MPharm, Pharmacist at Royal Hampshire County Hospital, Romsey Road, Winchester, United Kingdom.
Keywords: Anti-Bacterial Agents, Drug Resistance, Microbial



Background: Antimicrobial Stewardship and The Start Smart – Then Focus strategy provide guidelines aimed at improving the increasing trend of antibiotic resistance. The aim of this study was to assess whether antibiotics were being prescribed at Royal Hampshire County Hospital (a district general hospital), in accordance with the hospital’s and the NICE guidelines and whether this followed the Start Smart – Then Focus approach.


Methods: During November 2016, medical notes of 12 randomly selected in-patients of Royal Hampshire County Hospital on 45 antibiotics, were used to measure the dynamics of their prescriptions.


Results: 91% of the 45 prescriptions were in accordance with hospital guidelines, 82% of cases had appropriate samples sent before commencing antibiotics, 5% out of 27% had a planned switch from intravenous administration to oral (the remaining 73% were initially started on oral regimes) and 80% had planned stop dates.


Conclusion: Appropriate samples, stop dates, planning and documentation in patient notes must be improved with regards to antibiotic use.



1. Costelloe C, Metcalfe C, Lovering A, Mant D, D Hay A. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. British Medical Journal. 2010;304:c2096. doi:10.1136/bmj.c2096
2. Dr. Pathiraja. Antimicrobial Stewardship Start Smart – Then Focus: Guidance for Antimicrobial Stewardship for SHSCT [Internet]. 2015 Oct. Available from: http://www.southernguidelines.hscni.net/?wpfb_dl=220 [Accessed 22nd January 2017].
3. NICE Guidance. Antimicrobial Stewardship: Prescribing Antibiotics (KTT9). 2015 Jan. Available from: https://www.nice.org.uk/guidance/ktt9/resources/antimicrobial-stewardship-prescribing-antibiotics-1632178559941 [Accessed 22nd January 2017].
4. Llewelyn M. J, Fitzatrick J. M, Darwin E, Tonkin-Crine S, Gorton C, Paul J, et al. The antibiotic course has had its day. British Medical Journal. 2017;358:j3418. Available from: http://www.bmj.com/content/358/bmj.j3418 [Accessed November 8th 2017].
5. World Health Organization Antimicrobial Resistance Fact Sheet Updated October 2017. http://www.who.int/mediacentre/factsheets/fs194/en/ [Accessed November 6th 2017].
6. NICE Guidance. Antimicrobial Stewardship: Systems and Processes for Effective Antimicrobial Medicine Use (NG15). 2015 Aug. Available from: https://www.nice.org.uk/guidance/ng15/resources/antimicrobial-stewardship-systems-and-processes-for-effective-antimicrobial-medicine-use-1837273110469 [Accessed January 22nd 2017].
7. NICE Guidance. Antimicrobial Stewardship (QS121). 2016 April Available from: https://www.nice.org.uk/guidance/qs121/resources/antimicrobial-stewardship-75545353537477 [Accessed 22nd January 2017].
8. Kumar A, Roberts D, E. Wood K, Light B, E. Parrillo J, Sharma S et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006 Vol. 34, No. 6
9. Public Health England. Start Smart – Then Focus Antimicrobial Stewardship Toolkit for English Hospitals Updated March 2015 [Internet]. 2015 March. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/417032/Start_Smart_Then_Focus_FINAL.PDF
[Accessed 24th January 2017].
10. Davies S. Annual Report of the Chief Medical Officer 2011: Volume Two. Infections and the Rise of Antimicrobial Resistance. Available from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/138331/CMO_Annual_Report_Volume_2_2011.pdf [Accessed 4th August 2017].
11. Start Smart Then Focus Prescribers checklist. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/366944/Secondary_care_prescribers_checklist.pdf
12. Iechyd Cyhoeddus Cymru Public Health Wales. Antimicrobial Stewardship: “Start Smart – Then Focus” Guidance for Antimicrobial Stewardship for Hospitals in Wales. Available from: http://www.wales.nhs.uk/sitesplus/documents/888/Public%20Health%20Wales%20Antimicrobial%20Stewardship%20Guidance.pdf [Accessed 28th January 2017].
13. Lockwood AR, Bolton NS, Winton MD, Carter JT. Formalization of an antimicrobial stewardship program in a small community hospital. American Journal of Health-System Pharmacy.2017; 74(17 Supplement 3). Available from http://www.ajhp.org/content/74/17_Supplement_3/S52 [Accessed on 4th September].
14. Barlam TF, Cosrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an antibiotic stewardship program; guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical Infectious Diseases. 2016; 62(10): e51-e77. Available from https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciw118 [Accessed 6th September 2017].
15. MicroGuide. Available from: http://www.microguide.eu/ [Accessed 25th June 2017].
16. Huttner A, Harbarth S, Carlet J, Cosgrove S, Goossens H, Holmes A, et al. Antimicrobial Resistance: a global view from the 2013 World Healthcare-Associated Infections Forum. Antimicrobial Resistance and Infection Control. 2013;2: 31. Available from https://aricjournal.biomedcentral.com/articles/10.1186/2047-2994-2-31 [Accessed 5th September 2017].
17. Berrevoets MAH, Oever JT, Sprong T, Van Hest RM, Groothuis I, Van Heijl I, et al. Monitoring, documenting and reporting the quality of antibiotic use in the Netherlands: a pilot study to establish a national antimicrobial stewardship registry. BMC Infectious Diseases. 2017;17: 565. Available from https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2673-5 [Accessed 6th September 2017].
How to Cite
Lee-A-Ping, K., Saeed, K., Dryden, M., & Sim, G. (2017). Dynamics of Antibiotic Prescription in Royal Hampshire County Hospital in November 2016: A Prospective Study. International Journal of Medical Students, 5(3). Retrieved from http://ijms.info/index.php/IJMS/article/view/15
Short Communication