Background and importance Sexually transmitted diseases are the most common cause of urethritis and cervicitis. Neisseria gonorrhoeae and Chlamydia trachomatis are frequently involved in the development of these infections. Guidelines have recently updated treatment recommendations due to the increasing prevalence of antimicrobial resistance.
Aim and objectives To assess the appropriateness of empirical antibiotic therapy for cervicitis and urethritis prescribed in the emergency department (ED).
Material and methods We designed an observational, descriptive and retrospective study. Inclusion criteria: adult patients with suspected cervicitis or urethritis who attended the ED of a tertiary hospital in 2020. Patients with suspected pelvic inflammatory disease, prostatitis and those who required hospital admission were excluded.
Recommendations for the empirical treatment include the combination of ceftriaxone 500 mg intramuscularly (single dose) plus azithromycin 1000 mg oral (single dose) or ceftriaxone 500 mg intramuscularly (single dose) plus doxycycline 100 mg oral twice daily for 7 days.
Appropriateness of empirical antibiotic therapy was evaluated taking into account four aspects: indication, dosing, duration of therapy and route of administration. In this way, patients could be classified as undertreated or overtreated.
Data were obtained from the electronic medical record, the electronic prescription program and the discharge summary. Ethical approval was obtained from the institutional review board.
Results 176 patients were included, mean age was 28.9 years (SD 7.7) and 90.9% were men. The most commonly prescribed treatment was the combination of ceftriaxone and azithromycin (83.0%).
The percentage of patients that received inadequate treatment was 72.7%. The total number of drug errors was 148.
The most frequent cause was undertreatment (55.5%) related to underdosing (50.7%), particularly with regard to ceftriaxone. The percentage of errors related to indication was 10.8%, dosing 85.8%, duration 3.4% and route of administration 0%.
33.3% of the patients treated with doxycycline did not collect the medication at the pharmacy to complete the antibiotic course.
Conclusion and relevance A high percentage of patients who attended the ED for cervicitis or urethritis received an inappropriate empirical antibiotic regimen. The main reason was undertreatment due to underdosing. The use of a standard order set could optimise antimicrobial therapy.
Conflict of interest No conflict of interest
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