AB092. Antibiotic prescription in acute cholecystitis and cholangitis: a review of local practice

Background: Acute cholecystitis and cholangitis are some of the most common presentations on the acute surgical ward, with the mainstay of treatment being intravenous or oral antibiotic therapy, IV fluids and analgesia. Poor compliance with antibiotic guidelines can potentially lead to a worsening clinical condition and prolonged hospital stay.

Methods: A 3-week prospective review of antibiotic prescription in all patients admitted with suspected or confirmed acute cholecystitis or ascending cholangitis. Twenty-two patients admitted within audit window, 18% of which received correct antibiotics. Teaching was subsequently delivered to the surgical team on current antibiotic guidelines and appropriate escalation. Information posters were then designed and displayed in the emergency department and surgical wards. Guidelines and posters were also included in trust induction pack.

Results: Following education on correct prescription, a further audit period was carried out. Twenty-five patients were admitted with suspect or confirmed diagnosis, 84% of which received correct antibiotic therapy as per local guidelines. Correct education to surgical and emergency department staff led to an improvement of 66% in compliance to local antibiotic guidelines. A third audit cycle was performed following a change in junior doctor rotations. Compliance to antibiotic guidelines returned at 86%, illustrating continued improvement in current practice.

Conclusions: Education and implementation of a poster lead to significant and sustained improvement in antibiotic guidelines compliance. Correct antibiotic therapy can ultimately lead to improved patient safety and avoid future potential antibiotic resistance.

Keywords: Acute cholecystitis; cholangitis; antibiotics