Antibiotic prescription practices and their relationship to outcome in South Africa: findings of the prevalence of infection in South African intensive care units (PISA) study

S Afr Med J. 2012 Jun 14;102(7):613-6. doi: 10.7196/samj.5833.


Background: The emergence of multidrug-resistant, extensively resistant and pan-resistant pathogens and the widespread inappropriate use of antibiotics is a global catastrophe receiving increasing attention by health care authorities. The antibiotic prescription practices in public and private intensive care units (ICUs) in South Africa are unknown.

Objective: To document antibiotic prescription practices in public and private ICUs in South Africa and to determine their relationship to patient outcomes.

Methods: A national database of public and private ICUs in South Africa was prospectively studied using a proportional probability sampling technique.

Results: Two hundred and forty-eight patients were recruited. Therapeutic antibiotics were initiated in 182 (73.5%), and 54.9% received an inappropriate antibiotic initially. De-escalation was practised in 33.3% and 19.7% of the public and private sector patients, respectively. Antibiotic duration was inappropriate in most cases. An appropriate choice of antibiotic was associated with an 11% mortality, while an inappropriate choice was associated with a 27% mortality (p=0.01). The mortality associated with appropriate or inappropriate duration of antibiotics was 17.6% and 20.6%, respectively (p=0.42).

Conclusion: Inappropriate antibiotic prescription practices in ICUs in the public and private sectors in South Africa are common and are also associated with poor patient outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Infections / drug therapy*
  • Bacterial Infections / epidemiology*
  • Drug Prescriptions / statistics & numerical data
  • Drug Resistance, Microbial
  • Guideline Adherence / statistics & numerical data
  • Hospitals, Private / organization & administration*
  • Hospitals, Public / organization & administration
  • Humans
  • Intensive Care Units / organization & administration*
  • Outcome Assessment, Health Care
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prevalence
  • Prospective Studies
  • South Africa / epidemiology


  • Anti-Bacterial Agents