Antimicrobial Stewardship: A Quality Improvement Project to Reduce Overuse of the ‘4C Antibiotics’ In Primary Care

Emma Kerr

Antimicrobial stewardship, primary care, ‘4C antibiotics’, Clostridium difficile

Introduction: The World Health Organisation recognises antimicrobial resistance (AMR) as a significant threat to global health. Studies have shown that the ‘4C antibiotics’ (clindamycin, ciprofloxacin and other quinolones, co-amoxiclav and cephalosporins) are associated with an increased risk of Clostridium difficile infection. A Care Quality Commission (CQC) inspection of a Medical Centre in Berkshire, UK found a culture of immediate antibiotic prescribing for acute minor illness.

Methods: An audit was conducted to assess how many patients were prescribed a course of one of the ‘4C antibiotics’. An intervention was implemented to improve antibiotic stewardship. Posters were displayed in consultation rooms; General Practitioners were reminded of the ‘Antimicrobial prescribing and stewardship competencies’ guidance published by Public Health England; and staff members were reminded of the importance of antimicrobial stewardship at a team meeting.

Results: The total number of ‘4C antibiotics’ prescribed during the first period audited was 87. During the second period audited, this decreased by 14.9% to 74 prescriptions. Out of the 74 patients prescribed one of the ‘4C antibiotics’ in the second period, only 49 had a reason for the prescription documented on the electronic record system. One of these patients who was prescribed antibiotics without a documented clinical indication went on to develop a Clostridium difficile infection nine days later, potentially as a result of taking unnecessary antibiotics.

Conclusion: This study is limited by a relatively small sample size and the COVID-19 pandemic as a significant confounding factor. However, this quality improvement project demonstrates that a small-scale, low-cost intervention has the potential to have a positive impact by raising clinician awareness of antimicrobial stewardship and reducing overuse of the ‘4C antibiotics’.

https://doi.org/10.31871/WJRR.16.2.5