Appropriateness of antibiotic prescribing in the Emergency Department

Abstract

BackgroundAntibiotics are some of the most commonly prescribed drugs in the Emergency Department (ED) and yet data describing the overall appropriateness of antibiotic prescribing in the ED is scarce.ObjectivesTo describe the appropriateness of antibiotic prescribing in the ED.MethodsA retrospective, observational study of current practice. All patients who presented to the ED during the study period and were prescribed at least one antibiotic were included. Specialists from Infectious Disease, Microbiology and Emergency Medicine and a Senior Pharmacist assessed antibiotic appropriateness against evidence-based guidelines.ResultsA total of 1019 (13.6%) of patient presentations involved the prescription of at least one antibiotic. Of these, 640 (62.8%) antibiotic prescriptions were assessed as appropriate, 333 (32.7%) were assessed as inappropriate and 46 (4.5%) were deemed to be not assessable. Adults were more likely to receive an inappropriate antibiotic prescription than children (36.9% versus 22.9%; difference 14.1%, 95% CI 7.2%–21.0%). Patients who met quick Sepsis-related Organ Failure Assessment (qSOFA) criteria were more likely to be prescribed inappropriate antibiotics (56.7% versus 36.1%; difference 20.5%, 95% CI, 2.4%–38.7%). There was no difference in the incidence of appropriate antibiotic prescribing based on patient gender, disposition (admitted/discharged), reason for antibiotic administration (treatment/prophylaxis) or time of shift (day/night). ConclusionsInappropriate administration of antibiotics can lead to unnecessary adverse events, treatment failure and antimicrobial resistance. With over one in three antibiotic prescriptions in the ED being assessed as inappropriate, there is a pressing need to develop initiatives to improve antibiotic prescribing to prevent antibiotic-associated patient and community harms.

Utilization Pattern of Antibiotics and Patient Care Indicators in the Teaching Hospitals, Islamabad, Pakistan

“…Higher utilization of antibiotics in SOD was reported in previous published studies [9,10] and ED is an important setting for addressing antibiotic utilization, given that it sits at the interface of the community and the hospital [11,12]. Therefore, we selected SOD and ED, as these are important settings for addressing inappropriate antibiotic prescribing practices.…”

Picking the low‐hanging fruit: Why not choose oral antibiotics for skin and soft‐tissue infections in the emergency department

“…A recent Australian study showed that over one in eight (13.6%) of all 7497 patients presenting during the study period received antibiotics in the ED. Of these, three‐quarters were given i.v., although fewer than 5% met qSOFA criteria for sepsis . A panel of experts found that over one in three of these were inappropriate.…”

Cost of inappropriate antimicrobial use for upper respiratory infection in Japan

“…If two or more assessors did not reach an agreement for any diagnosis code, then all six experts reviewed the case at a round table until a consensus was reached. The validity of this approach has been shown in previous studies [11,12]. Details of the discussion process to judge appropriateness of antibiotic prescription are available in Supplementary file 1.…”