Background Antibiotics represent one of the most prescribed therapeutic agents in the Emergency Department (ED). It is considered that 26% to 62% of outpatient antibiotic prescriptions are made in this area. About 30% to 50% of these prescriptions are inappropriate.
Purpose To assess the appropriateness of antibiotic prescriptions in the ED of a tertiary hospital to conform to the local empirical antibiotic treatment guidelines.
Material and methods Observational, retrospective study including patients who attended the ED, during November 2016, with an antibiotic prescription. To assess the appropriateness of antibiotic prescriptions, they were compared to local empirical antibiotic treatment guidelines. Data were collected from the medical records of patients.
Results Six hundred and seventy-six patients were included, 386 females (57. 1%), mean age 47.4±21.2 years. Patients’ diagnoses were: 27.2% (184) urinary tract infections (UTI), 24.1% (163) lower respiratory tract infections, 15.4% (104) skin and soft tissue infections (SSTI), 13.8% (93) upper respiratory tract infections, 11.8% (80) oral infections, 2.7% (18) genital and sexually transmitted infections, 1.6% (11) gastrointestinal infections, 0.3% (two) ocular infections and 3.1% (21) other (where there were no registers of infection or could not be categorised in any of the previous locations). The most prescribed antibiotic families were: 44.1% (298) penicillins, 21.3% (144) fluoroquinolones, representing more than 60% of all antibiotic prescriptions. The most prescribed antibiotics by location were: fosfomycin trometamol in UTI (32.1%), levofloxacin in lower respiratory tract (46.2%) y amoxicillin/clavulanate in upper respiratory tract (46.6%), SSTI (62.5%) and oral infections (71.6%). In 56.8% (384) of the prescriptions, the use of an antibiotic drug was indicated. Nevertheless, the appropriate antibiotic was selected only in 62% (238) of the prescriptions. An appropriate dosage and duration of antibiotic treatment was selected in 828% (197) and 45.4% (108) of the prescriptions, respectively. In 22.9% and 35.1% of the analysed episodes, patients required previous or subsequent medical assistance.
Conclusion Appropriateness of antibiotic prescriptions was low. Noncompliance was mainly due to an overuse of antibiotics when not indicated, incorrect treatment duration and overuse of broad spectrum antibiotics. The need for subsequent medical assistance could be related to treatment failure. These data reinforce the need to develop an antimicrobial stewardship programme in the ED, where emergency medicine pharmacists could be decisive in influencing inappropriate antimicrobial use and by enhancing adherence to local empirical antibiotic treatment guidelines.
No conflict of interest
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