Adherence to Guidelines on Empiric Use of Antibiotics in the Emergency Room

Abstract

Physicians' compliance with hospital guidelines to empiric antibiotics in ER was high. Adherence to guidelines was associated with a better outcome. Local susceptibility patterns to antibiotics need to be actively monitored. Prompt administration of antibiotics in the ER is likely to have a favorable outcome on survival, yet larger studies are required to establish this conclusively.

Non-adherence to antibiotic prescription guidelines in treating urinary tract infection of children: a population-based study in Taiwan

“…A Canadian study evaluating concordance with guidelines for antibiotic prescriptions for all infection‐related illness in community practices and reported that 39% of antibiotic prescriptions were not adherent to guidelines [15]. An Israeli study of physician compliance to hospital guidelines for empiric use of antibiotics in emergency rooms, reported a non‐adherence rate of 11.6% [16]. Comparisons of the above study findings were not feasible as rates of adherence to antibiotics prescription may be dependent upon patient disease and settings.…”

Serial and panel analyses of biomarkers do not improve the prediction of bacteremia compared to one procalcitonin measurement

“…To include more resistant but often less prevalent pathogens, the empirical therapy of a severe infection is usually broad-spectrum. 5,10 The downside of this strategy is that the prescribed antibiotics are often more broad-spectrum than necessary 11 or even are used in the absence of a bacterial infection. 12,13 This may have potentially deleterious consequences such as anaphylactic reactions, antibiotic resistance, and high costs.…”

Non-adherence to antimicrobial treatment guidelines results in more broad-spectrum but not more appropriate therapy

“…A high adherence of 90% to local antimicrobial therapy guidelines in patients with a suspected or documented infection (pneumonia, cellulitis or erysipelas, urosepsis, febrile neutropenia, or meningitis) has been described [8]. However, the investigated guidelines were developed by internal medicine specialists for their own use in patients admitted to the internal medicine wards or the ICU.…”

“…The choice of the empirical antimicrobial therapy in sepsis mainly depends on the suspected site of infection and the antimicrobial susceptibility of the expected pathogens. To include more resistant but often less prevalent pathogens, the empirical therapy of a severe infection is usually broad-spectrum [4, 8]. …”

“…Due to geographical differences in pathogens and antimicrobial susceptibility, many countries and hospitals have their own antimicrobial treatment guidelines based on local epidemiological data, existing literature, and expert opinion. Although many hospitals have implemented local antimicrobial treatment guidelines, there is a wide variation in the reported adherence to these guidelines [5, 8–10]. …”