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Potential impact of national recommendations to use short course antibiotic therapy on antibiotic use in the emergency department of a UK hospital: retrospective observational study
  1. Neil Powell,
  2. Liam Wade,
  3. Rumaysah Iqbal-elahi,
  4. Caitlin McDonald,
  5. Ryan Philips,
  6. Rhys Owens,
  7. Amani Amir,
  8. Steven Cho,
  9. Tracy Nampa,
  10. Deborah Lim,
  11. Kevin Tai,
  12. Mark Jadav
  1. Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK
  1. Correspondence to Neil Powell, Royal Cornwall Hospitals NHS Trust, TRURO TR1 3LJ, Cornwall, UK; neil.powell2{at}


Background and importance The National Institute for Health and Care Excellence (NICE) antimicrobial prescribing guidelines for common infections recommend short course antimicrobial therapy in order to reduce antibiotic associated harm.

Objective To quantify the opportunity to reduce antibiotic use in an emergency department (ED) through adoption of these short antibiotic course recommendations.

Design, settings and participants A retrospective observational study in an ED in the UK with 95 000 attendances a year. Patients managed in the ED between 1 December and 31 December 2019 with the following infections were identified: acute otitis media, human and animal bites, pyelonephritis, lower urinary tract infections, cellulitis, cough, infective exacerbation of chronic obstructive pulmonary disease, pneumonia, sore throat, sinusitis, and diverticulitis.

Outcome measure Excess antibiotic use due to either a protracted course length, or not meeting criteria for antibiotics.

Results 395 patients (260 adults and 135 children) were identified. Of the 1215 days of antibiotic therapy, 198 (16%) were excess because of protracted course lengths. In terms of antibiotic defined daily doses (DDD), there were 1201.5 antibiotic DDD prescribed, of which 232 (19%) DDD were excess because of protracted course lengths. If both protracted courses and unnecessary antibiotic use were included, then 321 (27%) DDD were excess. Excess antibiotic use and total antibiotic use by infection group were: 123/546 (23%) DDD in lower respiratory tract infection, 46/59 (79%) in upper respiratory tract infection, 44/231 (19%) in upper and lower urinary tract infection, 0/113 (0%) cellulitis, 77/180 (43%) bites, and 30/40 (75%) diverticulitis. Excess antibiotic use, as a proportion of all antibiotic use in the ED, was 321/4291 (7.5%) DDD, and of whole hospital antibiotic use, the ED’s excess use was 321/33 566 (0.96%).

Conclusion Adoption of NICE antibiotic prescribing guidelines for common infections has the potential to reduce total antibiotic use in the ED by 7.5% and contribute to the hospital-wide antibiotic stewardship programme.

  • emergency medicine
  • evidence-based medicine
  • microbiology
  • clinical medicine
  • pharmacy service
  • hospital

Data availability statement

Data are available upon reasonable request. not applicable.

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Data availability statement

Data are available upon reasonable request. not applicable.

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