PP 4 - Rational empirical antibiotic prescribing practices in a Tertiary Care Hospital in Sri Lanka: A clinical audit based on medical students’ reflective reports on medical students’ reflective reports

Fernando TRP, Samaranayake KGMI, Jayawardhana HASDR, Heiyanthuduwa HPPD , Department of Microbiology, Faculty of Medicine, Wayamba University of Sri Lanka

Abstract

Introduction

Rational empirical antibiotic prescribing is crucial for improving patient outcomes and reducing antimicrobial resistance. This audit assessed adherence to national guidelines and identified gaps in prescribing practices at a tertiary care hospital in Sri Lanka.

Objectives

This study evaluated the rationality of empirical antibiotic prescribing using medical students’ reflective reports, focusing on the appropriateness of antibiotic selection, dose, route, timing, culture sampling and subsequent modification based on culture and sensitivity results.

Design, setting, and methods

A descriptive retrospective clinical audit was conducted at Teaching Hospital Kurunegala using medical students’ reflective reports from multiple inpatient units (June–August 2025). Students selected one hospitalized patient on empirical antibiotics and completed a structured data collection template. The data extraction template and scoring system were expert-validated for face and content validity. Incomplete reports were excluded, and two investigators independently extracted data. Antibiotic prescribing was assessed against Sri Lankan National Empirical Antibiotic Guidelines using six parameters (drug choice, dose, route, timing, culture before antibiotics, and de-escalation). Each parameter was scored as 1 or 0, and cases were classified as rational (5–6), partially rational (3–4), or irrational (0–2). Descriptive statistics were used for analysis.

Results

Among 158 reports reviewed, 110 clinical cases were analyzed. Cases were from Medicine (38.18%), Surgery (25.45%), Orthopaedics (10.00%), Paediatrics (4.55%), and other wards (21.82%). The mean age of patients was 55.05 ± 19.13 years, and 57.27% were male. The most common infections were skin and soft tissue (30.00%), urinary tract (27.27%), and respiratory tract infections (16.36%). Overall, 69.09% of prescriptions were rational, 7.27% partially rational, and 23.64% irrational. Compliance was highest for culture collection and de-escalation (85.45% each), followed by appropriate antibiotic choice (76.36%), route (73.64%), dose (67.27%), and timing (66.36%).

Conclusion

The audit found that 69.09% of antibiotic prescriptions were rational, while 30.91% were partially rational or irrational, indicating scope for improvement in adherence to prescribing guidelines.