Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Jun;31(3):209-216.
Epub 2018 May 16.

[Appropriateness of antimicrobial prescriptions in the emergency department of a tertiary hospital]

[Article in Spanish]
L Yunquera-Romero  1 , I Márquez-Gómez, A Henares-López, M J Morales-Lara, C Gallego Fernández, R Asensi-Díez
Affiliations
Observational Study

[Appropriateness of antimicrobial prescriptions in the emergency department of a tertiary hospital]

[Article in Spanish]
L Yunquera-Romero et al. Rev Esp Quimioter. 2018 Jun.

Abstract
in English, Spanish

Objective: Antibiotics are widely prescribed in the Emergency Department (ED), representing 26-62% of outpatient antibiotic prescriptions. Around 40% of antibiotic prescriptions in hospitalized patients are inappropriate or unnecessary. The aim of the study was to assess the appropriateness of antibiotic prescriptions according to local empirical antibiotic treatment guidelines, in the ED of a tertiary hospital.

Methods: Observational, retrospective study including patients attending the ED in November 2016, with an antibiotic prescription, excluding those from residents.

Results: A total of 676 patients were included, 57.1% women, mean age 47.4 ± 21.2 years. Patient's diagnoses were 27.2% urinary tract infections (UTI), 24.1% lower respiratory tract infections, 15.4% skin and soft tissue infections (SSTI), 13.8% upper respiratory tract infections, 11.8% oral infections, 2.7% genital/sexually transmitted infections, 1.6% gastrointestinal infections, 0.3% ocular infections and 3.1% other. The most prescribed antibiotic families were: 44.1% penicillins, 21.3% fluoroquinolones. The most prescribed antibiotics were: fosfomycin trometamol in UTI (32.1%), levofloxacin in lower respiratory tract (46.2%) and amoxicillin/clavulanate in oral infections (71.6%), SSTI (62.5%) and upper respiratory tract (46.6%). In 56.8% (384) of the prescriptions antibiotics were indicated. An appropriated antibiotic was selected in 62% (238) of the prescriptions. Appropriated dosage and duration were selected in 82.8% (197) and 45.4% (108) of the prescriptions, respectively.

Conclusions: Appropriateness of antibiotic prescriptions was low, mainly due to an overuse of antibiotics when not indicated, broad spectrum and incorrect treatment duration. These data reinforce the need to enhance adherence to local empirical antibiotic treatment guidelines by developing an antimicrobial stewardship program in the ED.

Introducción: España es el undécimo país europeo con mayor número de prescripciones antibióticas ambulatorias, estimándose en el área de Urgencias entre el 26-62%. Alrededor del 40% de las prescripciones antibióticas en el medio hospitalario son inapropiadas o innecesarias. El objetivo del estudio fue analizar la adecuación de las prescripciones antibióticas a las guías empíricas locales en el área de Urgencias de un hospital de tercer nivel.

Material y métodos: Estudio observacional, retrospectivo de pacientes adultos atendidos en el área de urgencias de un hospital de tercer nivel con una prescripción antibiótica, excluyéndose aquellas realizadas por médicos residentes. Período de estudio: noviembre de 2016.

Resultados: Se incluyeron 676 pacientes, 57,1% mujeres, media de edad 47,4 ± 21,2 años. Localización de la infección: 27,2% tracto urinario (ITU), 24,1% tracto respiratorio superior, 15,4% piel y partes blandas (IPPB), 13,8% tracto respiratorio inferior, 11,8% orales, 2,7% genitales/transmisión sexual, 1,6% gastrointestinales, 0,3% oculares y 3,1% otros. Las familias más prescritas: 44,1% penicilinas, 21,3% fluoroquinolonas. Los antibióticos más prescritos: fosfomicina trometamol en ITU (32,1%), levofloxacino en tracto respiratorio inferior (46,2%) y amoxicilina-clavulánico en cavidad oral (71,6%), infecciones de piel y partes blandas (IPPB) (62,5%) y en tracto respiratorio superior (46,6%). El tratamiento antimicrobiano estaba indicado en 56.8% de las prescripciones, seleccionándose un antibiótico adecuado en el 62% de los casos. La dosis y duración seleccionadas fueron correctas en 82,8% y 45,4% de las prescripciones, respectivamente.

Conclusiones: El grado de adecuación a las guías fue bajo debido al uso de antibióticos sin indicación, con un mayor espectro del necesitado y a una duración inadecuada de los tratamientos. Es necesario incrementar la adherencia a las guías empíricas locales, dentro de programas de optimización del uso de antimicrobianos (PROA) en el área de urgencias.

PubMed Disclaimer

Conflict of interest statement

Los autores declaran no tener ningún conflicto de intereses.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Zatorski C, Zocchi M, Crosgrove SE, Rand C, Brooks G, May L. A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections. BMC Infect Dis. 2016;16: 638 DOI: 10.1186/s12879-016-1972-6 - DOI - PMC - PubMed
    1. Atif M, Azeem M, Sarwar MR, Shahid S, Javaid S, Ikram H, et al. . WHO/INRUD prescribing indicators and prescribing trends of antibiotics in the Accident and Emergency Department of Bahawal Victoria Hospital, Pakistan: Springerplus; 2016;5(1):1928 DOI: 10.1186/s40064-016-3615-1 - DOI - PMC - PubMed
    1. Bishop BM. Antimicrobial Stewardship in the Emergency Department: Challenges, Opportunities, and a Call to Action for Pharmacists. J Pharm Pract. 2016;29(6):556-563. DOI:10.1177/0897190015585762 - DOI - PubMed
    1. Fernández-Urrusuno R, Flores-Dorado M, Vilches-Arenas A, Serrano-Martino C, Montero-Balosa MC. Appropriateness of antibiotic prescribing in a primary care area: a cross-sectional study. Enferm Infecc Microbiol Clin. 2014;32(5):285-92. DOI: 10.1016/j.eimc.2013.05.004. - DOI - PubMed
    1. Trinh Trang D, Klinker Kenneth P. Antimicrobial Stewardship in the Emergency. Department. Infect Dis Ther. 2015;4(Suppl 1): 39–50. DOI: 10.1007/s40121-015-0084-8 - DOI - PMC - PubMed

Publication types

Substances