Antibiotic prescribing in patients who presented to the emergency department with dog bites: A descriptive review of current practice

Abstract

Objective: To describe the current practice of prophylactic antibiotic prescribing for patients presenting to the Emergency Department (ED) with a dog bite, and compare management against existing guidelines. Method: We performed a descriptive retrospective study on all consecutive patients who presented to one tertiary teaching hospital and one regional district hospital in Southeast Queensland between the 1st of July 2017 and the 30th of June 2018 with a presentation of a dog bite. Data on demographics and management were collected from the electronic medical record using a standardised data collection tool. Risk factors supporting prophylaxis were taken from the electronic Therapeutic Guidelines (eTG). Results: Of the 336 patients included for analysis, 299 received antibiotics, of which 23 were for established infection. 276 (82% of overall cohort) received a prescription for prophylactic antibiotics, either in hospital (ED or admitting ward) and/or on discharge. Of the 178 patients who received prophylactic antibiotics in hospital, 91 (51.1%) received intravenous (IV) antibiotics. Of the patients who presented to ED without a previously established infection 271 (86.6%) received prophylactic antibiotics on discharge. Over one quarter (27.5%) of patients who were given prophylactic antibiotics did not meet any high-risk factors as outlined in guidelines. Conclusion: Prophylactic antibiotics are extensively used for patients with dog bites. There is scope to rationalise antibiotic use and route of antibiotic administration in patients with dog bites.

Use of antibiotics in patients who were attacked by animals that can transmit rabies

“…The median age of the bite patients was similar to that found in other studies (28.0-36.0 years; Baxter et al, 2020;Jaindl et al, 2016;Nkomo et al, 2020;Pfortmueller et al, 2013), with a predominance of men, as identified in the majority of previous studies (51.8%-55.0%; Baxter et al, 2020;Jaindl et al, 2012;Ngugi et al, 2018;Nkomo et al, 2020;Pfortmueller et al, 2013;Wangoda et al, 2019;Williams et al, 2021); however, in other reports, a higher proportion of women has been described (50.6%-62.0%; Birdsey et al, 2016;Jaindl et al, 2016;Morzycki et al, 2019).…”

“…In this study, more than two-thirds of patients received a prescription for an antibiotic for prophylactic purposes, a finding similar to that documented in Switzerland (70.4%; Pfortmueller et al, 2013) and Canada (67.0%; Morzycki et al, 2019) but different from that described in Australia, where the proportion of antibiotic prescriptions was even higher (86.6%; Baxter et al, 2020); in countries such as the USA, Austria and South Africa, the antibiotic prescription rates were lower (13.9%-45.1%; Jaindl et al, 2012Jaindl et al, , 2016Nkomo et al, 2020;Tabaka et al, 2015). Additionally, 4.3% of the patients already had a bacterial superinfection at the time seeking medical care, a finding that is consistent with what was previously published in North America (4.4%-5.2%; McGuire et al, 2018;Tabaka et al, 2015) but lower than that found in Austria (10.7%-19.0%; Jaindl et al, 2012;Jaindl et al, 2016).…”

“…However, there is no information on the use of antibiotics in this group of patients (Arias Caicedo et al, 2019;Instituto Nacional de Salud, 2020), but, in reports from countries in North America, Europe and Oceania, it has been described that a significant proportion of patients receive prophylactic antibiotics (Baxter et al, 2020;Morzycki et al, 2019;Pfortmueller et al, 2013). Therefore, the aim of the present study was to determine the use of inappropriate antibiotics among a group of patients from Colombia who were attacked by animals that can transmit rabies.…”

“…In this way, in the national report for the year 2020, it was identified that 97.2% of patients with dog or cat bite wounds received washing with soap and water, 11.7% had sutures, 11.0% were given anti‐rabies serum, and 36.4% were given the rabies vaccination scheme (Instituto Nacional de Salud, 2020). However, there is no information on the use of antibiotics in this group of patients (Arias Caicedo et al, 2019; Instituto Nacional de Salud, 2020), but, in reports from countries in North America, Europe and Oceania, it has been described that a significant proportion of patients receive prophylactic antibiotics (Baxter et al, 2020; Morzycki et al, 2019; Pfortmueller et al, 2013). Therefore, the aim of the present study was to determine the use of inappropriate antibiotics among a group of patients from Colombia who were attacked by animals that can transmit rabies.…”

Indications for medical antibiotic prophylaxis and potential targets for antimicrobial stewardship intervention: a narrative review

“…AP is only recommended for selected patients (See Table 1 for suggested indications as well as relevant references [11,21,22]). However, AP is used in a significant proportion of patients beyond the recommended indications [23].…”