Survey of antibiotic prescribing in a district general hospital. II. Lower respiratory tract infection.

A 28 day survey of all antibiotic prescriptions in a district general hospital included a brief interview with the prescriber of each prescription. One hundred and nineteen antibiotic courses were stated, by the prescriber, to be for the treatment of lower respiratory tract infection. By combining the prescriber's clinical evidence, laboratory data, and radiographic findings, an "index of infection" was produced for 94 patients. This index reflected features associated with bacterial infection of the lower respiratory tract and suggested that 49% of the antibiotic courses prescribed were justifiable, 11% were questionable, and 40% were unjustifiable. The choice of antibiotic was usually appropriate to the prescriber's diagnosis. Over 80% of the antibiotics used were of the penicillin group. Ampicillin, the single most frequently prescribed drug, accounted for 60% of the prescriptions. The frequency of diagnosis of chest infection increased with age. Almost 40% of patients over 81 years old who were admitted to hospital during the survey were prescribed antibiotics for chest infection. A higher proportion of older than of younger patients had low indices of infection.