Overuse of parenteral antibiotics for wound care in an urban emergency department.
This study compared patterns of parenteral antibiotic treatment by emergency physicians with literature-derived guidelines in the management of wound care. All patients who received parenteral antibiotics as part of wound management in an urban general emergency department (ED) (annual volume 65,000) and did not receive subsequent consultation or admission were prospectively studied for 4 weeks (July 18 to August 15, 1994). Data collected included age, sex, antibiotic, route of administration, dose, cost, diagnosis, and board certification of emergency physician. Antibiotic choice and dose were reviewed by study-blinded physicians and compared with criteria based on a review of the current wound care literature. Wound characteristics justifying antibiotic prophylaxis were derived from the literature and included immunocompromised patient, wounds with debris or occurring under contaminated circumstances, wounds with cellulitis or purulent drainage, wounds older than 18 hours, and crush injuries. The study included 72 patients, and 13 (18%) antibiotic discrepancies were found. Cefazolin (n = 49 [64%]) and ceftriaxone (n = 25 [35%]) were the most commonly prescribed parenteral antibiotics, with cefazolin used in 9 (69%) and ceftriaxone in 4 (31%) of discrepant cases. There were not significant differences in discrepant parenteral antibiotic by emergency physicians' board certification. There were no significant demographic differences between patients receiving discrepant and nondiscrepant antibiotics. The excess cost of discrepant parenteral antibiotics during this small study period was $380. Approximately one fifth of the parenteral antibiotics prescribed during wound care administered in the ED were discrepant with current recommendations derived from the literature.
Department of Emergency Medicine, Earl K. Long Medical Center, Baton Rouge, LA 70805, USA.
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Waldrop
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Prejean
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Singleton
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D002568:Certification; D002648:Child; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006786:Hospitals, Urban; D006801:Humans; D007262:Infusions, Intravenous; D008145:Louisiana; D008297:Male; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D016037:Single-Blind Method; D014947:Wounds and Injuries / Q000188:drug therapy*
D000900:Anti-Bacterial Agents