title: Antibiotic use for emergency department patients with acute diarrhea: Prescribing practices, patient expectations, and patient satisfaction.
abstract: OBJECTIVE
  Physicians commonly prescribe antibiotics to meet patient expectations, even when antimicrobials are unnecessary. We evaluated factors emergency physicians consider in prescribing antibiotics to patients with diarrhea and examined patient expectations, physician-perceived patient expectations, and patient satisfaction.
  
  
  METHODS
  Adults and children presenting with acute diarrhea to 1 of 10 academic emergency departments (EDs) were enrolled in this prospective observational cohort study. Adult patients and guardians of enrolled children were asked about treatment expectations before their physician encounter and about satisfaction with their medical care at discharge. Physicians were asked about factors influencing management decisions and their perceptions of patients' expectations.
  
  
  RESULTS
  Of 104 patients enrolled, 25% received antibiotics. Physicians were more likely to prescribe antibiotics when features suggestive of bacterial enteritis were present (unadjusted odds ratio [OR] 2.5; 95% confidence interval [CI] 1.1 to 3.9). Physicians were also more likely to prescribe antibiotics when they believed patients expected them (unadjusted OR 2.3; 95% CI 1.1 to 4.4) but correctly identified such expectations in only 33% of instances. Satisfaction with care was reported by 100% of patients receiving antibiotics and 90% of those not receiving antibiotics (95% CI for difference of 10%, 3% to 17%).
  
  
  CONCLUSIONS
  Physicians in academic EDs prescribe antibiotics for acute diarrhea to about 1 patient in 4 and are more likely to do so if signs or symptoms compatible with bacterial enteritis are present. Physicians' assessments of patients' expectations for therapy were accurate in only 1 of 3 patients but were nevertheless associated with antibiotic prescription. Patient satisfaction was weakly associated with receipt of antibiotics.
authors.affiliation: Temple University School of Medicine, Philadelphia, PA 19140, USA. david.karras@temple.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Karras
authors.forename: Samuel
authors.initials: S
authors.lastname: Ong
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Moran
authors.forename: Janet
authors.initials: J
authors.lastname: Nakase
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kuehnert
authors.forename: William R
authors.initials: WR
authors.lastname: Jarvis
authors.forename: David A
authors.initials: DA
authors.lastname: Talan
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D015331:Cohort Studies; D003967:Diarrhea / Q000188:drug therapy* / Q000209:etiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents