Assessment of guideline-concordant antimicrobial prescription for inpatients with lower respiratory tract infection in southern Sri Lanka

Thumbnail Image
Limited Access
This item is unavailable until:



Journal Title

Journal ISSN

Volume Title


Background: Lower respiratory tract infection (LRTI) is one of the most common reasons for hospitalization globally. Inappropriate antimicrobial prescriptions are common for LRTI, which might lead to antimicrobial resistance (AMR) and poor patient outcomes. In this study, we identified the proportion of receiving appropriate antimicrobial prescriptions and features associated with inappropriate prescriptions among inpatients with LRTI in Sri Lanka. Methods: We conducted a point-prevalence study of antimicrobial prescription among inpatients at 5 public hospitals in southern Sri Lanka in June-August 2017. Sociodemographic and clinical data were extracted from the medical chart and descriptive analyses were performed. The appropriateness of prescriptions for LRTI was evaluated according to the 2016 National Guidelines by the Sri Lanka College of Microbiologists. Multivariable logistic regression was used to identify features associated with inappropriate antimicrobial prescriptions. Results: Of 935 surveyed patients who were receiving antimicrobials, 187 were receiving antimicrobials for the treatment of LRTI. Of these 187 patients, 121 (64.7%) were adults ≥18 years old, and 101 (54.0%) were male. The average number of antimicrobials per LRTI patient was 1.7±0.0. Adults and children received similar numbers (1.8±0.1 vs 1.5±0.1, respectively; P = 0.167), and penicillins, third-generation cephalosporins, and macrolides were the most commonly prescribed antimicrobials in both age groups. Only 65 (34.8%) patients received guideline-concordant therapies for LRTI. There was no difference in receiving guideline-concordant therapy among different age groups (≤5, 5-17, 18-64, ≥65 years old; P = 0.580) or ward types (medical, pediatric, mixed medical/ surgical ward, intensive care; P = 0.299). Among patients receiving inappropriate antimicrobial prescriptions, undertreatment accounted for the largest proportion (55.7%), followed by partially-concordant prescriptions (30.3%). The potential risk factors for non guideline-concordant antimicrobial prescription was the numbers of antimicrobials (OR, 0.10; 95% CI, 0.05-0.21), diabetes mellitus (OR, 5.22; 95% CI, 1.22-22.27), and methicillin-resistant Staphylococcus aureus (MRSA) treatment (OR, 4.96; 95% CI, 1.74-14.13). Conclusions: This study showed a high proportion of inappropriate prescriptions of antimicrobials for LRTI in southern Sri Lanka. Further studies are needed to identify reasons for inappropriate prescriptions and targets for antimicrobial stewardship interventions.






Wang, Shurui (2024). Assessment of guideline-concordant antimicrobial prescription for inpatients with lower respiratory tract infection in southern Sri Lanka. Master's thesis, Duke University. Retrieved from


Dukes student scholarship is made available to the public using a Creative Commons Attribution / Non-commercial / No derivative (CC-BY-NC-ND) license.