Piperacillin/Tazobactam is the first line broad spectrum antibiotic for treatment of febrile neutropenia in many Australian hospitals. Increasingly, its use has been transposed to the treatment of oncology patients with non-neutropenic fever due to its ease of administration and broad-spectrum coverage. However, this is often against antibiotic prescribing guidelines. Broad-spectrum antibiotic use can lead to an increased incidence of antibiotic-related diarrhea and an increased rate of infection with multi-resistant organisms.
We performed a clinical audit of Piperacillin/Tazobactam use over a 9 month period in Gold Coast University Hospital medical oncology inpatients. Included patients were febrile and non-neutropenic (absolute neutrophil count >1.0) at presentation. Piperacillin/Tazobactam use was assessed by reviewing patient medication charts. Patients were categorised by potential sources of sepsis based on their admission clerking. Piperacillin/Tazobactam use was classified as appropriate or inappropriate based on the national therapeutic guidelines for antibiotics.
1160 patient admissions were audited in total. Of these, 269 (23.2%) admissions were for a febrile illness. 219 patients met the inclusion criteria for non-neutropenic fever. Piperacillin/Tazobactam was prescribed inappropriately in 87.3% of these patients. There was little variation in prescription habits from month to month. Piperacillin/Tazobactam was most commonly prescribed for presumed respiratory causes of fever; with many of these occasions occurring in the winter months. Only 5 patients in the cohort were neutropenic at 48 hours after admission.
Febrile, non-neutropenic patients make up a significant proportion of medical oncology admissions. Piperacillin/Tazobactam was prescribed inappropriately for the majority of these patients. We hope that this data will help us educate doctors to guide more appropriate antibiotic prescription to lead to improved patient outcomes.