High variability among Emergency Departments in 3rd-generation cephalosporins and fluoroquinolones use for community-acquired pneumonia

Abstract

Cephalosporins and fluoroquinolones use in pneumonia is highly variable among EDs. The majority of these prescriptions are avoidable. Antibiotic stewardship programs should be implemented to restrict their use in EDs.

Effect of a Health Care System Respiratory Fluoroquinolone Restriction Program To Alter Utilization and Impact Rates of Clostridium difficile Infection

“…Based on institutional guidelines, between 30 and 81% of fluoroquinolone use is inappropriately prescribed within the emergency department and inpatient hospital settings (2,3).…”

Are third-generation cephalosporins associated with a better prognosis than amoxicillin–clavulanate in patients hospitalized in the medical ward for community-onset pneumonia?

“…The first study population originated from a French academic centre (Centre Hospitalier Universitaire de Nantes, Nantes, France), the study period ranging from January 2002 to December 2015. Patients who were hospitalized between 2002 and 2013 have been described previously [5,20]. The second study population originated from a previously reported multicentre study in seven other French hospitals, including two academic centres [5].…”

“…Patients who were hospitalized between 2002 and 2013 have been described previously [5,20]. The second study population originated from a previously reported multicentre study in seven other French hospitals, including two academic centres [5]. Local hospital guidance limited the use of 3GCs for community-onset pneumonia in two of the eight hospitals [5].…”

Incidence and proportion of avoidable prescriptions of third generation cephalosporins and fluoroquinolones in an emergency department

“…Chez les patients traités aux urgences pour pneumonie, nous avons estimé que 67 % des prescriptions de C3G et/ ou de FQ étaient évitables, c'est-à-dire qu'elles auraient pu être remplacées par un antibiotique à moins large spectre, sélectionnant moins de résistances bactériennes [9]. Par ailleurs, la proportion de traitement par C3G injectable a fortement augmenté entre 2002 et 2012, et il existe une forte variation de la proportion de patients traités par C3G et/ou FQ entre structures d'urgences, indépendamment de la gravité des patients [9,10].…”

“…Par ailleurs, la proportion de traitement par C3G injectable a fortement augmenté entre 2002 et 2012, et il existe une forte variation de la proportion de patients traités par C3G et/ou FQ entre structures d'urgences, indépendamment de la gravité des patients [9,10]. Ces constats concordants indiquent qu'il existe une surprescription de C3G, et dans une moindre mesure de FQ dans les infections respiratoires basses traitées aux urgences.…”