Cefalexin prescribing appropriateness in general practice: an evaluation study

INTRODUCTION: Antibiotic misuse and overuse, among other factors, are the main drivers of increased antimicrobial resistance. Although cefalexin is generally recommended as a second-line agent, recent trends in Aotearoa New Zealand (NZ) indicate increased community use, highlighting the need for closer scrutiny. AIM: This preliminary study aimed to assess the appropriateness and guideline compliance of cefalexin prescribing. METHODS: We conducted a cross-sectional study reviewing all cefalexin prescriptions issued at a single urban medical centre in Ōtautahi Christchurch, NZ, during July-August 2023. Retrieved prescriptions were assessed for guideline compliance and clinical appropriateness using a modified audit survey based on national and regional guidelines. RESULTS: We identified 27 cefalexin prescriptions provided to 25 patients (16 female, 20 NZ European; median age 48.9 years, IQR 49.7). Soft tissue (n = 11, 42.3%) and genito-urinary infections (n = 10, 38.5%) were the most common indications. Of the assessable prescriptions (n = 26), 14 (53.8%) were guideline compliant, and 15 (57.7%) were clinically appropriate. Indications were documented in 22 cases (84.6%) - 6 on the prescription and 19 in the clinical record. DISCUSSION: This exploratory study identifies areas for targeted antimicrobial stewardship interventions in general practice to promote improved prescribing practices. A larger multicentre study is planned to further investigate prescribing patterns and appropriateness.