Timbrook TT, et al. - This article was written with the objective to ascertain the assessments of opportunities to improve antibiotic prescribing in an emergency department. Consistent with national outpatient prescribing, inappropriate antibiotic prescribing in the emergency departments (ED) occurred in 39% of cases with the highest rates seen among patients with bronchitis, upper respiratory tract infection (URTI), and skin and soft tissue infection (SSTI). Antimicrobial stewardship programs may benefit by focusing on initiatives for these conditions among ED patients. In addition, the creation of local guideline pocketbooks for these and other conditions may serve to improve prescribing practices and meet the Core Elements of Outpatient Stewardship recommended by the Centers for Disease Control and Prevention.

Methods

• For this study, they conducted a retrospective chart review.
• This study was performed among a random sample of non-admitted, adult patients who received an antimicrobial prescription in the ED from January 1 to December 31, 2015.
• Appropriateness was measured utilizing the Medication Appropriateness Index and was based on provider adherence to local guidelines.
• Additional information collected included patient qualities, initial diagnoses, and other chronic medication utilization.

Results

• Of 1579 ED antibiotic prescriptions in 2015, they reviewed a total of 159 (10.1%) prescription records.
• The most frequently recommended antimicrobial classes included penicillins (22.6%), macrolides (20.8%), cephalosporins (17.6%), and fluoroquinolones (17.0%).
• The most common signs for antibiotics were bronchitis or upper respiratory tract infection (URTI) (35.1%), followed by skin and soft tissue infection (SSTI) (25.0%), both of which were the most widely recognized reason for unnecessary prescribing (28.9% of bronchitis/URTIs, 25.6% of SSTIs).
• Of the antimicrobial prescriptions reviewed, 39% met criteria for inappropriateness.
• Among 78 prescriptions with a consensus on appropriate indications, 13.8% had inappropriate dosing, duration, or expense.