Evaluation of Appropriateness of Ceftriaxone Use in the Emergency Department

Alternative antibiotics with a lower ecological impact were suggested for 55.2% of relevant ceftriaxone prescriptions in a university hospital emergency department setting during 2016, according to data published in The European Journal of Clinical Microbiology and Infectious Disease.

All ceftriaxone prescriptions in the first complete week of each month during 2016 in the Grenoble university hospital emergency department were analyzed using an infectious disease specialist referent in antibiotic prescriptions. Ceftriaxone was considered appropriate if justified (antibiotic required), relevant (ceftriaxone is an indicated choice for given symptoms/presumed infection), and appropriately adapted (in terms of dose, route, and period of administration).

 Of the 327 patients included in the study, ceftriaxone was deemed not appropriate in 37.6%, unjustified in 13.5%, not relevant in 12.8%, and not adapted in 11.3%. Factors associated with unjustified prescriptions were urinary, dermatologic, and less frequent infection sites (P < .001). Irrelevant prescription factors included patients carrying multi-resistant bacteria (P =.002) or already following an antibiotic prescription at admission (P =.024). Factors associated with poorly adapted prescriptions included patients with a creatinine rate >150 μmol/L (P < .001) and septic shock (P =.032). Alternative suggestions with a lower ecological impact were suggested in 55.2% of relevant prescriptions.

Investigators concluded that for more than half of the appropriate prescriptions an alternative therapy was also justified, suggesting “a possible evolution of our prescriptions, considering [that] we have to use antibiotics in a more ecological way.” They recommended several possible measures such as organizing a repetitive medical update for physicians by infectious disease specialists and the use of cefotaxime where appropriate, as it involves less resistance.

Reference

Gennai S, Ortiz S, Boussat B, François P, Pavese P. Evaluation of ceftriaxone prescriptions in the emergency department of a university hospital: an urgent need for improvement and alternative therapy [published August 1 2018]. Eur J Clin Microbiol Infect Dis.  doi:10.1007/s10096-018-3339-yb