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

Hamill, Laura; Thi, Yu Chen E.; Keijzers, Gerben

doi:10.1111/1742-6723.13383

Cited by 7 publications

(6 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This possibly reflects a bias towards intravenous antibiotics and is consistent with previous ED literature (17). A preference for IV administration may be the result of cognitive miserliness since a peripheral intravenous cannulae often is in situ (18), perceived higher efficacy of intravenous antibiotics compared to oral (19) or the (mistaken) belief that oral medications should not be given whilst a patient is fasted for surgery. Fifty-four patients met this condition, however, guidelines allow oral medications with small sips of water less than two hours pre-operatively and, in the absence of significant trauma which could delay gastric emptying, impending surgery is not in itself a reason for intravenous medication administration (20).…”

Section: Discussionsupporting

confidence: 74%

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

Baxter

Denny²,

Keijzers

2020

Emerg Medicine Australasia

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 74%

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

Baxter

Denny²,

Keijzers

2020

Emerg Medicine Australasia

Self Cite

View full text Add to dashboard Cite

show abstract

“…This is supported by prior research where patients diagnosed with cellulitis felt misinformed about the condition, including the duration of symptoms. 16,19 Semi-synthetic penicillins (e.g. flucloxacillin/dicloxacillin) were the most frequently prescribed antibiotics, in keeping with local guidelines.…”

Section: Discussionmentioning

confidence: 75%

Cellulitis in the Emergency Department: A prospective cohort study with patient‐centred follow‐up

Nightingale,

Etheridge,

Sweeny

et al. 2024

Emerg Medicine Australasia

Self Cite

View full text Add to dashboard Cite

ObjectiveThere is substantial practice variation in the management of cellulitis with limited prospective studies describing the course of cellulitis after diagnosis. We aimed to describe the demographics, clinical features (erythema, warmth, swelling and pain), patient‐reported disease trajectory and medium‐term follow‐up for ED patients with cellulitis.MethodsProspective observational cohort study of adults diagnosed with cellulitis in two EDs in Southeast Queensland, Australia. Patients with (peri)orbital cellulitis and abscess were excluded. Data were obtained from a baseline questionnaire, electronic medical records and follow‐up questionnaires at 3, 7 and 14 days. Clinician adjudication of day 14 cellulitis cure was compared to patient assessment. Descriptive analyses were conducted.ResultsThree‐hundred patients (mean age 50 years, SD 19.9) with cellulitis were enrolled, predominantly affecting the lower limb (75%). Cellulitis features showed greatest improvement between enrolment and day 3. Clinical improvement continued gradually at days 7 and 14 with persistent skin erythema (41%) and swelling (37%) at day 14. Skin warmth was the feature most likely to be resolved at each time point. There was a discrepancy in clinician and patient assessment of cellulitis cure at day 14 (85.8% vs. 52.8% cured).ConclusionsA clinical response of cellulitis features can be expected at day 3 with ongoing slower improvement over time. Over one third of patients had erythema or swelling at day 14. Patients are less likely than clinicians to deem their cellulitis cured at day 14. Future research should include parallel patient and clinician evaluation of cellulitis to help develop clearer definitions of treatment failure and cure.

show abstract

“…More importantly, patients with a PIVC are at continued risk of developing complications. These patients are also more likely to receive intravenous therapy that may not be appropriate [ 31 ]. It is predictable that these patients will have higher financial costs compared to those who receive venepuncture.…”

Section: Discussionmentioning

confidence: 99%

“…It is predictable that these patients will have higher financial costs compared to those who receive venepuncture. Although pathology collection using a PIVC may be reasonable if intravenous medication, fluids or contrast is required, a PIVC for the sole use of specimen collection can lead to downstream adverse events [ 31 ]. Our study defined an idle PIVC as unused within 24 hours of insertion, excluding a normal saline flush or the collection of pathology via the PIVC.…”

Section: Discussionmentioning

confidence: 99%

Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices

Evison¹,

Sweeny

Ranse

et al. 2021

Scand J Trauma Resusc Emerg Med

Self Cite

View full text Add to dashboard Cite

Background Unused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment. Methods This was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February–18 March 2017 and 5 January–4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression. Results A total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%–31.9%) remained idle at 24 hours. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs. 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs. 7.4%). Nursing staff inserted idle PIVCs at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC inserted in the ED was the only factor significantly (p ≤ .001) predicting an idle outcome (Odds Ratio: 2.4; 95% CI 1.7–3.3). Conclusion One-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of antecubital insertion. Reasons for these differences are not well understood and requires more targeted research.

show abstract

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

Cited by 7 publications

References 31 publications

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

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

Cellulitis in the Emergency Department: A prospective cohort study with patient‐centred follow‐up

Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices

Contact Info

Product

Resources

About