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
. 2019 Feb 1;74(2):515-520.
doi: 10.1093/jac/dky447.

Appropriateness of antibiotic prescribing in the Emergency Department

Kerina J Denny  1   2 , Jessica G Gartside  1 , Kylie Alcorn  1 , Jack W Cross  1 , Samuel Maloney  1 , Gerben Keijzers  1   3   4
Affiliations
Observational Study

Appropriateness of antibiotic prescribing in the Emergency Department

Kerina J Denny et al. J Antimicrob Chemother. .

Abstract

Background: Antibiotics are some of the most commonly prescribed drugs in the Emergency Department (ED) and yet data describing the overall appropriateness of antibiotic prescribing in the ED is scarce.

Objectives: To describe the appropriateness of antibiotic prescribing in the ED.

Methods: A retrospective, observational study of current practice. All patients who presented to the ED during the study period and were prescribed at least one antibiotic were included. Specialists from Infectious Disease, Microbiology and Emergency Medicine and a Senior Pharmacist assessed antibiotic appropriateness against evidence-based guidelines.

Results: A total of 1019 (13.6%) of patient presentations involved the prescription of at least one antibiotic. Of these, 640 (62.8%) antibiotic prescriptions were assessed as appropriate, 333 (32.7%) were assessed as inappropriate and 46 (4.5%) were deemed to be not assessable. Adults were more likely to receive an inappropriate antibiotic prescription than children (36.9% versus 22.9%; difference 14.1%, 95% CI 7.2%-21.0%). Patients who met quick Sepsis-related Organ Failure Assessment (qSOFA) criteria were more likely to be prescribed inappropriate antibiotics (56.7% versus 36.1%; difference 20.5%, 95% CI, 2.4%-38.7%). There was no difference in the incidence of appropriate antibiotic prescribing based on patient gender, disposition (admitted/discharged), reason for antibiotic administration (treatment/prophylaxis) or time of shift (day/night).

Conclusions: Inappropriate administration of antibiotics can lead to unnecessary adverse events, treatment failure and antimicrobial resistance. With over one in three antibiotic prescriptions in the ED being assessed as inappropriate, there is a pressing need to develop initiatives to improve antibiotic prescribing to prevent antibiotic-associated patient and community harms.

PubMed Disclaimer

References

    1. Sherwin R, Winters ME, Vilke GM. et al. Does early and appropriate antibiotic administration improve mortality in Emergency Department patients with severe sepsis or septic shock? J Emerg Med 2017; 53: 588–95. - PubMed
    1. Tamma PD, Avdic E, Li DX. et al. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med 2017; 177: 1308–15. - PMC - PubMed
    1. Denny KJ, Cotta MO, Parker SL. et al. The use and risks of antibiotics in critically ill patients. Expert Opin Drug Saf 2016; 15: 667–78. - PubMed
    1. May L, Cosgrove S, L'Archeveque M. et al. A call to action for antimicrobial stewardship in the emergency department: approaches and strategies. Ann Emerg Med 2013; 62: 69–77.e2. - PMC - PubMed
    1. May L, Gudger G, Armstrong P. et al. Multisite exploration of clinical decision making for antibiotic use by emergency medicine providers using quantitative and qualitative methods. Infect Control Hosp Epidemiol 2014; 35: 1114–25. - PMC - PubMed

Publication types

Substances