Compliance with the national and WHO antibiotic treatment guidelines for respiratory tract infections and their association with clinical and economic outcomes in Vietnam: an observational study.

Background and objectives: Antibiotic guidelines are a component of antimicrobial stewardship for optimizing antibiotic use. To evaluate the compliance with the national guidelines and the WHO AWaRe Antibiotic Book for the empirical treatment for community-acquired pneumonia (CAP) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in critical care units (CCUs) in Vietnam.

Methods: In this 7-day observational study, 51 participating CCUs consecutively enrolled patients aged ≥18 years from March to July 2019. We assessed the compliance for empirical antibiotic prescription using the national guidelines and the WHO AWaRe Antibiotic Book.

Results: We included 500 patients with CAP and 249 patients with AECOPD. The rates of overall compliance with the national guidelines and the WHO AWaRe Antibiotic Book were 54.4% (272/500) and 43.2% (216/500) for CAP; and 48.2% (120/249) and 7.2% (18/249) for AECOPD, respectively. The overall case fatality at 7 days was 4.0% (20/500) in patients with CAP, and 2.0% (5/249) in patients with AECOPD with no significant difference between those receiving compliant and non-compliant regimens by either guideline. The average cost of empirical antibiotic regimens for CAP was lowest at US$3.10 ($3.02-$3.17) per Defined Daily Dose (DDD) for the full compliant regimens versus US$15.26 ($12.72-$17.81) per DDD for the non-compliant regimen according to the WHO AWaRe Antibiotic Book.

Conclusions: Our study indicates that the compliance with the antibiotic guidance was suboptimal in CCUs in Vietnam. Compliance with guidelines for empirical antibiotic therapy could be associated with lower costs.