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N Z Med J. 2018 May 18;131(1475):35-43.

Inappropriate prescribing of antibiotics following discharge after major surgery: an area for improvement.

Author information

Clinical Microbiologist, Department of Microbiology, Auckland City Hospital, Auckland.
Evaluation Manager, New Zealand Health Quality & Safety Commission, Wellington.
Antimicrobial Stewardship Pharmacist, Adult Infectious Diseases Service, Auckland City Hospital, Auckland.



This study aims to determine the indications for antibiotic use in patients discharged following major surgery at Auckland City Hospital (ACH); to determine if the indications were appropriate and to identify opportunities where antimicrobial stewardship interventions would be beneficial.


This was a retrospective study of adult patients who were dispensed an antibiotic within the first two days of discharge after major surgery at ACH between 1 January 2013 and 31 December 2013. The indication for antibiotic use was determined and subsequently classified as either 'appropriate', 'not assessable' or 'inappropriate'.


Among the 378 patients analysed, an indication for antibiotic use was not documented in 52 patients (13.8%). Antibiotics were prescribed for an established infection in 172 patients (45.5%), as empiric therapy in 100 patients (26.4%), and as prolonged surgical antimicrobial prophylaxis in 41 patients (10.8%). Overall, nearly half of the antibiotic courses dispensed (48.7%) were either 'inappropriate' or the indication was 'not assessable'.


This study demonstrates that a significant proportion of antibiotics prescribed in patients discharged following surgery are inappropriate and there is need for enhanced antimicrobial stewardship in this area.


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