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.