scholarly journals Appropriateness of Antibiotic Prescribing in Patients Discharged From a Community Hospital Emergency Department

2022 ◽  
pp. 10-19
Author(s):  
Emily Bauman ◽  
Justine Russell ◽  
Angela Morelli
Keyword(s):  
Emergency Department ◽  
Assessment Tool ◽  
Inappropriate Prescribing ◽  
Time Of Day ◽  
Common Disease ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Provider Type ◽  
Electronic Health Record Data ◽  
Prescribing Trends

IMPORTANCE: Every year, thousands of emergency department (ED) visits result in patients being discharged with oral antibiotic prescriptions. Published studies that assess the appropriateness of these antibiotic regimens are limited. PURPOSE: The purpose of this study was to examine the appropriateness of antibiotic prescriptions written for patients discharged from a community hospital’s ED. ENDPOINTS: The primary objective was to determine the overall percent of appropriate antibiotic prescriptions for patients discharged from the ED. Secondary objectives included the following: identify reasons for inappropriateness categorized by antibiotic selection, dose, duration, and allergies; identify the most common antibiotics prescribed inappropriately as well as the most common disease states that led to inappropriate prescribing of antibiotics; and analyze prescribing trends based on provider type and time of day the prescription was written. STUDY DESIGN AND METHODS: Patients eligible for inclusion were adults age 18 and older who presented to the ED during four chosen weeks in 2019 and who were discharged with oral antibiotics. Extracted electronic health record data was reviewed to identify the discharge diagnosis for each patient that meets the inclusion criteria. Pertinent information gathered from the patients’ medical records along with a validated antimicrobial assessment tool were utilized to determine the level of appropriateness of the prescribed antibiotic regimens. RESULTS: A total of 76% of the prescribed antibiotics were appropriate, 16% were inappropriate, and the remaining 8% were not assessable. Duration was the most common reason for a regimen to not be optimal. The most frequently inappropriately prescribed antibiotics included cephalexin (but it is noted cephalexin was included in almost half of the antibiotic regimens in this study), clindamycin, and azithromycin. Infections that were most frequently treated inappropriately were skin and soft tissue infections, dental infections, and sinusitis. Overall, medical residents prescribed the highest percent of appropriate regimens, and the time of day that had the highest percent of appropriate prescriptions was third shift (11 p.m. to 7 a.m.). CONCLUSION AND RELEVANCE: Almost half of all the nonoptimal antibiotic regimens had an excessive duration. Targeted local education efforts and future clinical decision support can facilitate appropriate prescribing of discharge antibiotics from the ED, ultimately improving antimicrobial stewardship within the community.

scholarly journals 218. Changes in Dental Antibiotic Prescribing in the United States, 2012–2017

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S111-S111
Author(s):  
Swetha Ramanathan ◽  
Connie H Yan ◽  
Colin Hubbard ◽  
Gregory Calip ◽  
Lisa K Sharp ◽  
...  
Keyword(s):  
The United States ◽  
Cross Sectional Study ◽  
Antibiotic Prescribing ◽  
Prescription Data ◽  
Oral Antibiotic ◽  
Sectional Study ◽  
Cross Sectional ◽  
Prescribing Trends ◽  
Adults And Children ◽  
Linear Regressions

Abstract Background Data suggest dental antibiotic prescribing is increasing with relatively less documented about prescribing trends in adults and children. Therefore, the aim was to evaluate trends in antibiotic prescribing by US dentists from 2012–2017. Methods This was a cross-sectional study of US dental prescribing using IQVIA Longitudinal Prescription Data from 2012 to 2017. Prescribing rates (prescriptions [Rx] per 100,000 dentists), mean days’ supply, and mean quantity dispensed were calculated monthly across eight oral antibiotic groups: amoxicillin, clindamycin, cephalexin, azithromycin, penicillin, doxycycline, fluoroquinolone, and other antibiotics. Descriptive frequencies and multiple linear regressions were performed to obtain trends overall and stratified by adults (≥ 18) and children (< 18). Results 220, 325 dentists prescribed 135 million Rx (94.0% in adults). 61.0% were amoxicillin, 14.4% clindamycin, 11.7% penicillin, 4.4% azithromycin, 4.3% cephalexin, 2.0% other antibiotics, 1.4% doxycycline, and 0.7% fluoroquinolones. Prescribing increased by 33 Rx/100,000 dentists (p< 0.0001) each month for all antibiotics. Amoxicillin (p< 0.0001) and clindamycin (p=0.02) prescribing rate increased by 73 and 5 Rx/100,000 dentists, respectively. Prescribing decreased by 8, 12, and 2 Rx/100,000 dentists for cephalexin (p< 0.0001), doxycycline (p< 0.0001), and fluoroquinolones (p=0.008), respectively. Mean days’ supply increased for amoxicillin, penicillin, and clindamycin (p< 0.0001), and decreased for cephalexin (p< 0.0001).Mean quantity dispensed decreased (p< 0.0001) for all groups except azithromycin and doxycycline. Among adults, cephalexin prescribing rates (7 Rx/100,000 dentist; p< 0.0001) and other antibiotics days’ supply (p< 0.0001) decreased. Among children, azithromycin prescribing rates (1 Rx/100,000 dentists, p=0.02), and fluoroquinolone and other antibiotics days’ supply (p< 0.0001) decreased. Conclusion These findings support dental antibiotic prescribing is increasing, specifically for amoxicillin and clindamycin. Further, trends differed between adults and children. Understanding what is driving these trends is important to target dental antibiotic stewardship efforts. Disclosures All Authors: No reported disclosures

Pharmacist-Driven Implementation of Outpatient Antibiotic Prescribing Algorithms Improves Guideline Adherence in the Emergency Department

2020 ◽  
pp. 089719002093097
Author(s):  
Kristin Stoll ◽  
Erik Feltz ◽  
Steven Ebert
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Guideline Adherence ◽  
Inappropriate Prescribing ◽  
Community Acquired Pneumonia ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Duration Of Therapy ◽  
Tract Infections ◽  
Selection Of

Background: Inappropriate prescribing of antibiotics has been identified as the most important modifiable risk factor for antimicrobial resistance. Objective: The purpose of this project was to improve guideline adherence and promote optimal use of outpatient antibiotics in the emergency department (ED). Methods: Prescribing algorithms for community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) were developed to integrate clinical practice guideline recommendations with local ED antibiogram data. Outcomes were evaluated through chart review of patients prescribed outpatient antibiotics by ED providers. The primary outcome was adherence to clinical practice guidelines, defined as the selection of an appropriate antibiotic agent, dose, and duration of therapy for each patient discharged. Results: When compared to patients discharged from the ED prior to algorithm implementation (N = 325), the post-implementation group (N = 353) received more antibiotic prescriptions that were completely guideline adherent (61.5% vs 11.7%, P < .00001). Post-implementation discharge orders demonstrated improvement in the selection of an appropriate agent (87.3% vs 45.5%, P < .00001), dose (91.5% vs 77.2%, P < .00001), and duration of therapy (71.1% vs 39.1%, P < .01). Additionally, fluoroquinolone prescribing rates were reduced (2.3% vs 12.3%, P < .00001). A reduction in all-cause 30-day returns to the ED or urgent care was observed (15.3% vs 21.5%, P = .036). Conclusion: Pharmacist-driven implementation of antibiotic prescribing algorithms improved guideline adherence in the outpatient treatment of CAP, SSTI, and UTI.

scholarly journals Antibiotic prescription among outpatients in a prefecture of Japan, 2012–2013: a retrospective claims database study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026251 ◽  
Author(s):  
Hideki Hashimoto ◽  
Hiroki Matsui ◽  
Yusuke Sasabuchi ◽  
Hideo Yasunaga ◽  
Kazuhiko Kotani ◽  
...  
Keyword(s):  
Health Insurance ◽  
Inappropriate Prescribing ◽  
Multivariable Analysis ◽  
Young Patients ◽  
Prescribing Patterns ◽  
Small Scale ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Gastrointestinal Infections ◽  
Tract Infections

ObjectivesTo investigate oral antibiotic prescribing patterns and identify factors associated with antibiotic prescriptions, with the aim of guiding future interventions to reduce inappropriate prescribing.DesignRetrospective cohort study.SettingDatabase of public health insurance claims in Kumamoto prefecture (Japan).ParticipantsBeneficiaries of the national or late elders’ health insurance system between April 2012 and March 2013.Main outcome measuresOf the 7 770 481 outpatient visits, 682 822 had a code for antibiotics (860 antibiotic prescriptions per 1000 population). Third-generation cephalosporins (35%), macrolides (32%) and quinolones (21%) were the most frequently prescribed. Acute respiratory tract infections (ARTIs), including viral upper respiratory infections (URI) (22%), pharyngitis (18%), bronchitis (11%) and sinusitis (10%) were the most frequently diagnosed for antibiotic prescribing, followed by gastrointestinal (9%), urinary tract (8%) and skin, cutaneous and mucosal infections (5%). Antibiotic prescribing rates for viral URI, pharyngitis, bronchitis, sinusitis and gastrointestinal infections were 35%, 54%, 53%, 57% and 30%, respectively. In multivariable analysis for ARTIs and gastrointestinal infections, patient age (10–19 years especially), patient sex (male) and facility scale (free-standing clinics or small-scale hospital-based clinics) were associated with increased antibiotic prescribing.ConclusionsBroad-spectrum antibiotics constituted 88% of oral outpatient antibiotic prescriptions. Approximately 70% of antibiotics were prescribed for ARTIs and gastroenteritis with modest benefit from antibiotic treatment. The quality of antibiotic prescribing needs to be improved. Antimicrobial stewardship interventions should target ARTIs and gastroenteritis, as well as young patients and small-scale institutions.

Sore throat in adults – does the introduction of a clinical scoring system improve the management of these patients in a secondary care setting?

2005 ◽  
Vol 119 (7) ◽  
pp. 550-555 ◽  
Author(s):  
S L Woolley ◽  
J M Bernstein ◽  
J A Davidson ◽  
D R K Smith
Keyword(s):  
Emergency Department ◽  
Sore Throat ◽  
Scoring System ◽  
Antibiotic Prescription ◽  
Inappropriate Prescribing ◽  
Antibiotic Prescribing ◽  
Number Of Patients ◽  
Clinical Scoring ◽  
System 2 ◽  
New Guidelines

Objective: To audit sore throat management in adults, introduce proforma-based guidelines and to reaudit clinical practice.Setting: Adult emergency department of an inner city teaching hospital.Methods: A literature search was carried out to identify relevant guidelines. In stage one, patients presenting to the emergency department with sore throat were identified retrospectively from the emergency department attendance register. Proformas were completed retrospectively. In stage two, new guidelines were introduced and staff educated about the guidelines. In stage three, patients presenting with sore throat were identified at triage and proformas were completed at time of consultation.Outcome Measures: (1) appropriate clinical assessment of the likelihood of bacterial infection using the clinical scoring system, (2) appropriateness of antibiotic prescription, (3) recommendation of supportive treatments to patients.Results: Introduction of a clinical scoring system reduced the inappropriate prescribing of antibiotics from 44 per cent to 11 per cent. Correct antibiotic prescription rose from 60 per cent to 100 per cent. Although the variety of advice given about supportive treatment increased, the actual number of patients receiving documented supportive advice fell from 67.8 per cent in stage one to 58 per cent in stage three.Conclusion: The introduction of clinically based guidelines for the diagnosis and management of sore throat in adults can reduce inappropriate antibiotic prescribing.

scholarly journals The Prescribing Trends of Metronidazole in The Outpatient Setting

2020 ◽  
pp. 24-29 ◽  
Author(s):  
Nehad J. Ahmed
Keyword(s):  
Public Hospital ◽  
Bacterial Resistance ◽  
Inappropriate Prescribing ◽  
Outpatient Setting ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Descriptive Data ◽  
Prescribing Pattern ◽  
Stewardship Program ◽  
Prescribing Trends

Aim: The aim of this study is to characterize the trends of metronidazole prescribing in outpatient setting in Alkharj. Methodology: This is a retrospective study includes evaluating outpatient antibiotic prescriptions from 01-01-2018 till 31-12-2018 in a public hospital Alkharj. The data were collected and analyzed using excel software and the descriptive data were represented by frequencies and percentages.                              Results: The majority of the metronidazole prescriptions were regular and only few prescriptions were urgent. The physicians who prescribed metronidazole were mainly residents who don’t have sufficient experience that may results in more inappropriate antibiotic prescribing patterns. Conclusion: The excessive use of metronidazole in addition to its prescribing by resident may results in inappropriate prescribing pattern that may lead to increase the adverse effect which may lead to increase the rate of bacterial resistance. More efforts are needed, especially by applying antimicrobial stewardship program, to ensure that metronidazole is prescribed correctly.

scholarly journals 1333. A Cross-Sectional Analysis of Inappropriate Outpatient Antibiotic Use in Children Insured by Kentucky Medicaid

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S678-S678
Author(s):  
Bethany A Wattles ◽  
Kahir S Jawad ◽  
Yana Feygin ◽  
Maiying Kong ◽  
Navjyot Vidwan ◽  
...  
Keyword(s):  
General Practitioners ◽  
Classification Scheme ◽  
Inappropriate Prescribing ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Provider Type ◽  
Research Support ◽  
Cross Sectional ◽  
Medical Claims ◽  
Patient Demographics

Abstract Background Kentucky (KY) consistently has one of the highest rates of outpatient pediatric antibiotic prescribing in the nation. Previous analyses identified significant variation in volume of antibiotic prescribing by geographic location, patient demographics, and provider type, but less is known about the appropriateness of this prescribing. We describe appropriateness of outpatient antibiotic prescribing in children insured by KY Medicaid. Methods We utilized KY Medicaid pharmacy and medical claims from 2017 for children &lt; 20 years. Patient demographic variables were abstracted from Medicaid enrollment data. Antibiotic prescriptions were identified by NDC and matched to medical claims within 3 days prior to fill date to identify corresponding diagnoses via ICD-10 codes. A previously published appropriateness classification scheme (Chua, BMJ 2019) was applied to categorize antibiotic prescriptions as “appropriate”, “potentially appropriate”, “inappropriate” or “not associated with indication”. Results Of the 779,751 antibiotic prescriptions included, 19.5% were appropriate, 45.3% were potentially appropriate, 20.8% were inappropriate, and 14.4% were not associated with an indication (Table 1). Inappropriate prescriptions were more common among children 0-2 years (24.4%) and those living in non-metro areas (22.2%). Antibiotics prescribed by general practitioners were also more likely to be inappropriate (22.2%). The most common diagnoses for each category are summarized in Table 2. Amoxicillin was the most commonly prescribed antibiotic in all categories. Azithromycin was more frequently prescribed for inappropriate indications or those not associated with a diagnosis code. Cefdinir was more common for appropriate and potentially appropriate indications. Table 1: Antibiotic Prescription Characteristics, 2017 Table 2: Top Diagnoses for Antibiotic Prescriptions by Category Conclusion Inappropriate antibiotic prescribing is more common among young children living in non-metro areas seen by general practitioners. Outpatient antibiotic stewardship interventions should target these patient demographics and provider types. This classification scheme to describe inappropriate prescribing is feasible for use in pediatric Medicaid patients and could serve as a valuable metric for provider feedback reports on antibiotic use. Disclosures Bethany A. Wattles, PharmD, Kentucky Medicaid (Grant/Research Support)Merck (Grant/Research Support) Michael J. Smith, MD, MSC.E, Kentucky Medicaid (Grant/Research Support)Merck (Grant/Research Support)

scholarly journals Improving antimicrobial prescribing for upper respiratory infections in the emergency department: Implementation of peer comparison with behavioral feedback

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
George F. Jones ◽  
Valeria Fabre ◽  
Jeremiah Hinson ◽  
Scott Levin ◽  
Matthew Toerper ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health System ◽  
Respiratory Infections ◽  
Inappropriate Prescribing ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
Diagnosis Code ◽  
Respiratory Condition ◽  
Attending Physicians ◽  
Behavioral Feedback

Abstract Objective: To reduce inappropriate antibiotic prescribing for acute respiratory infections (ARIs) by employing peer comparison with behavioral feedback in the emergency department (ED). Design: A controlled before-and-after study. Setting: The study was conducted in 5 adult EDs at teaching and community hospitals in a health system. Patients: Adults presenting to the ED with a respiratory condition diagnosis code. Hospitalized patients and those with a diagnosis code for a non-respiratory condition for which antibiotics are or may be warranted were excluded. Interventions: After a baseline period from January 2016 to March 2018, 3 EDs implemented a feedback intervention with peer comparison between April 2018 and December 2019 for attending physicians. Also, 2 EDs in the health system served as controls. Using interrupted time series analysis, the inappropriate ARI prescribing rate was calculated as the proportion of antibiotic-inappropriate ARI encounters with a prescription. Prescribing rates were also evaluated for all ARIs. Attending physicians at intervention sites received biannual e-mails with their inappropriate prescribing rate and had access to a dashboard that was updated daily showing their performance relative to their peers. Results: Among 28,544 ARI encounters, the inappropriate prescribing rate remained stable at the control EDs between the 2 periods (23.0% and 23.8%). At the intervention sites, the inappropriate prescribing rate decreased significantly from 22.0% to 15.2%. Between periods, the overall ARI prescribing rate was 38.1% and 40.6% in the control group and 35.9% and 30.6% in the intervention group. Conclusions: Behavioral feedback with peer comparison can be implemented effectively in the ED to reduce inappropriate prescribing for ARIs.

scholarly journals Antimicrobial Prescribing in the Emergency Department; Who Is Calling the Shots?

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 843
Author(s):  
Laura M. Hamill ◽  
Julia Bonnett ◽  
Megan F. Baxter ◽  
Melina Kreutz ◽  
Kerina J. Denny ◽  
...  
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Assessment Tool ◽  
Antibiotic Prescribing ◽  
Antimicrobial Prescribing ◽  
Likert Score ◽  
Surgical Subspecialty ◽  
Poor Outcomes ◽  
Record Review ◽  
Insight Into

Objective: Inappropriate antimicrobial prescribing in the emergency department (ED) can lead to poor outcomes. It is unknown how often the prescribing clinician is guided by others, and whether prescriber factors affect appropriateness of prescribing. This study aims to describe decision making, confidence in, and appropriateness of antimicrobial prescribing in the ED. Methods: Descriptive study in two Australian EDs using both questionnaire and medical record review. Participants were clinicians who prescribed antimicrobials to patients in the ED. Outcomes of interest were level of decision-making (self or directed), confidence in indication for prescribing and appropriateness (5-point Likert scale, 5 most confident). Appropriateness assessment of the prescribing event was by blinded review using the National Antibiotic Prescribing Survey appropriateness assessment tool. All analyses were descriptive. Results: Data on 88 prescribers were included, with 61% making prescribing decisions themselves. The 39% directed by other clinicians were primarily guided by more senior ED and surgical subspecialty clinicians. Confidence that antibiotics were indicated (Likert score: 4.20, 4.35 and 4.35) and appropriate (Likert score: 4.07, 4.23 and 4.29) was similar for juniors, mid-level and senior prescribers, respectively. Eighty-five percent of prescriptions were assessed as appropriate, with no differences in appropriateness by seniority, decision-making or confidence. Conclusions: Over one-third of prescribing was guided by senior ED clinicians or based on specialty advice, primarily surgical specialties. Prescriber confidence was high regardless of seniority or decision-maker. Overall appropriateness of prescribing was good, but with room for improvement. Future qualitative research may provide further insight into the intricacies of prescribing decision-making.

scholarly journals Inappropriate Antibiotic Prescribing for Respiratory Conditions Does Not Improve Press Ganey Patient Satisfaction Scores in the Emergency Department

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Michael S Pulia ◽  
Steven Hesse ◽  
Rebecca J Schwei ◽  
Lucas T Schulz ◽  
Ajay Sethi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Respiratory Tract ◽  
Satisfaction Score ◽  
Antibiotic Prescribing ◽  
Score Distribution ◽  
Electronic Health Record Data ◽  
Data Set ◽  
Patient Satisfaction Score ◽  
Patient Satisfaction Scores

Abstract Background The literature has mixed results regarding the relationship between antibiotic prescribing and patient satisfaction in the emergency department (ED) for antibiotic-inappropriate respiratory diagnoses. The objective of the study was to determine if ED patients who receive nonindicated antibiotic prescriptions for respiratory tract conditions have increased Press Ganey patient satisfaction scores compared with those who do not receive antibiotics. Methods This was a retrospective observational study. Using an administrative electronic health record data set from 2 EDs in the Midwest, we identified 619 ED encounters resulting in discharge for antibiotic-inappropriate respiratory diagnoses with a corresponding Press Ganey patient satisfaction survey. We compared sociodemographics, encounter variables, and overall Press Ganey patient satisfaction scores between those who did and did not receive antibiotics. We analyzed Press Ganey scores by categorical score distribution and as a dichotomized scale of top box (5) vs other scores. A logistic regression estimated the odds of a top box Press Ganey patient satisfaction score based on antibiotic prescribing while controlling for other covariates. Results In the final sample, 158 (26%) encounters involving antibiotic-inappropriate respiratory diagnoses involved an antibiotic prescription. There were no differences in sociodemographic, encounter or categorical, or top box Press Ganey overall patient satisfaction scores between the groups that did and did not receive inappropriate antibiotics. In the fully adjusted regression model, antibiotic prescriptions were not associated with increased odds of top box Press Ganey patient satisfaction score (odds ratio, 0.78; 95% CI, 0.53–1.14). Conclusions Our findings suggest that nonindicated antibiotic prescribing for respiratory tract conditions is not a primary driver of overall Press Ganey scores in the ED.

scholarly journals 147. Antibiotic Prescribing: Shorter is Also Better in the Emergency Department

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S185-S186
Author(s):  
Lisa Vuong ◽  
Darius Faison ◽  
Julie Thomson ◽  
Rachel Kenney ◽  
Susan L Davis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Infection Type ◽  
Inappropriate Prescribing ◽  
Generation Cephalosporin ◽  
Cross Sectional Study ◽  
Drug Event ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
National Guidelines ◽  
Cross Sectional

Abstract Background Published information suggests room for improvement in antibiotics prescribed on discharge from the emergency department (ED). The objective of this study was to evaluate antibiotic prescribing in the ED for uncomplicated infections of the lower respiratory tract (LRTI), urinary tract (UTI), and skin and skin structure (SSTI). Methods IRB-approved retrospective cross-sectional study of patients discharged from the ED from January to June 2019 at 6 locations. Inclusion: ≥ 18 years old and uncomplicated LRTI, UTI, or SSTI. Exclusion: hospital admission. Appropriate prescribing was defined having all three of the following correct per local and national guidelines: antibiotic selection, dose, and duration. Correct duration: 5 days for LRTI and SSTI; 3 days for trimethoprim-sulfamethoxazole (TMP-SMX), 5 days for nitrofurantoin (NFT), and 7 days for beta-lactams for UTIs. Endpoints within 7 days: antibiotic escalation, readmission to ED or hospital, any outpatient contact, and report of adverse drug event (ADE). Endpoints within 90 days: Clostridioides difficile infection (CDI). Descriptive and bivariable statistics were performed. Results Inappropriate prescribing: 77% (304) vs. appropriate 23% (89). Infection type: 47.8% SSTI, 30% UTI, and 22.1% LRTI. SSTI was associated with the greatest proportion of inappropriate prescribing at 89.4% (Figure 1). Comparisons for inappropriate vs. appropriate groups: 15.8% vs. 22.5% for beta-lactam allergy and 23.4% vs. 19.1% for cultures drawn in ED. Most common antibiotics for inappropriate vs. appropriate: first generation cephalosporin at 70.1% vs. 7.3% (p&lt; 0.05), TMP-SMX at 14.3% vs. 12.2% (p=0.75), and NFT at 7.8% vs. 65.9% (p&lt; 0.05). Prescriptions considered inappropriate were primarily driven by excess duration (Figure 2). Endpoints for inappropriate vs. appropriate groups: antibiotic escalation at 6.6% (2.8% were due to cultures drawn in the ED) vs. 1.1% (p=0.06), readmission at 8.6% vs. 9.0% (p=0.9), any outpatient contact at 18.4% vs. 19.1% (p=0.89), and report of ADE at 1.3% vs. 1.1%. No CDI in either group. Figure 1. Appropriateness of Discharge Prescriptions by Infection Type, N = 393 Figure 2. Subset Analysis: Reasons for Inappropriate Prescribing, n = 304 Conclusion The main reason for inappropriate prescribing in the ED was excess duration of therapy, making this an area of opportunity for future antibiotic stewardship improvement. Disclosures Rachel Kenney, PharmD, Medtronic, Inc. (Other Financial or Material Support, spouse is an employee and shareholder) Susan L. Davis, PharmD, Nothing to disclose

Sign in / Sign up

Export Citation Format

Share Document