A survey of antibiotic prescribing practices in Australian and New Zealand intensive care units

Crit Care Resusc. 2010 Sep;12(3):162-70.


Objective: To evaluate antibiotic prescribing practices in empirical and directed treatment of severe sepsis and septic shock in Australian and New Zealand intensive care units.

Design, setting and participants: Case vignette survey of intended antibiotic prescribing for ICU patients with sepsis associated with community-acquired pneumonia (CAP), intra-abdominal infection (IAI), hospital-acquired pneumonia (HAP) or an unidentified infectious cause (UIC). Eighty-four specialists and advanced trainees working in an ICU setting in Australia and New Zealand responded to a questionnaire survey conducted between February and May 2009.

Main outcome measures: Empirical and directed antibiotic therapy, including mode of administration, frequency of administration, dose and duration of therapy.

Results: A total of 656 antibiotics were empirically "prescribed", including 25 unique antibiotics. Combination therapy was prescribed in 82% of cases, with dual cover for CAP and triple therapy for IAI most common. Directed single-agent cover for Pseudomonas aeruginosa in HAP and flucloxacillin monotherapy for methicillin-sensitive Staphylococcus aureus bacteraemia were prescribed in 65% and 51% of cases, respectively. Supportive gentamicin therapy was commonly recommended (32% of all cases), predominantly in the form of once-daily dosing. Daily gentamicin dosage varied from 3 to 7mg/kg (excluding one outlier), and was largely compliant with recommendations (76% of doses being ≥5 mg/kg). Main areas of noncompliance with guidelines were provision of broader cover for resistant organisms and Β-lactam underdosing. Continuous and extended infusions were uncommon (5%).

Conclusions: Antibiotic prescribing was largely appropriate, but consideration of site-specific resistance profiles and avoidance of low dosing is advocated to provide appropriate upfront cover, prevent underdosing and reduce the risk of developing resistant organisms.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Australia
  • Cross Infection / prevention & control
  • Humans
  • Intensive Care Units*
  • New Zealand
  • Staphylococcus aureus*
  • Surveys and Questionnaires


  • Anti-Bacterial Agents