Do patients get the best deal when antibiotics are prescribed out of hours?

OBJECTIVE To investigate patients' compliance in obtaining follow on prescriptions after being prescribed a "starter pack" by the accident and emergency (A&E) department, and to assess the cost of the starter pack system. METHODS During a study period of two months, out of hours prescriptions of antibiotic starter packs in A&E were monitored prospectively to determine how many patients returned to the hospital pharmacy or to their general practitioner (GP) for the remainder of the prescribed course. Current costs of out of hours antibiotic prescriptions were calculated, as were the costs of providing a full course of antibiotics on the patient's first visit to the A&E department. RESULTS During the study period, 571 antibiotic items were prescribed as starter packs (three days' supply) to 437 patients. Of these, 232 (53%) chose to return to the hospital and 175 (40%) to their GP for the follow on prescription to complete their course. In 29 cases (7%) the information was not recorded and those patients were excluded from analysis. Only 50% of patients electing to obtain the follow on prescription from their GP did so compared with 83.7% of those electing to return to the hospital pharmacy. Failure to obtain the follow on prescription was termed "late primary non-compliance". There was an estimated annual saving to the hospital of Pounds 3131 if the patients were given the full course of antibiotics at their primary attendance at A&E. CONCLUSIONS Patients prescribed antibiotics out of hours should be dispensed full courses. This would eliminate late primary non-compliance at no extra cost to the health authority.