title: Evaluating antibiotic therapies prescribed to adult patients in the emergency department.
abstract: OBJECTIVE
  The proper use of antibiotics is a public health priority to preserve their effectiveness. Little data is available on outpatient antibiotic prescriptions, especially in the emergency department. We aimed to assess the quality of outpatient antibiotic prescriptions in our hospital.
  
  
  METHODS
  Retrospective monocentric study of antibiotic prescriptions written to adult patients managed at the emergency department without hospitalization (November 15th, 2012-November 15th, 2013). Prescriptions were evaluated by an infectious disease specialist and an emergency physician on the basis of local recommendations compiled from national and international guidelines.
  
  
  RESULTS
  A total of 760 prescriptions were reviewed. The most frequent indications were urinary tract infections (n=263; 34.6%), cutaneous infections (n=198; 26.05%), respiratory tract infections (n=101; 13.28%), and ENT infections (n=62; 8.15%). The most frequently prescribed antibiotics were fluoroquinolones (n=314; 40.83%) and amoxicillin-clavulanic acid (n=245; 31.85%). Overall, 455 prescriptions (59.86%) did not comply with guidelines. The main reasons for inadequacy were the absence of an indication for antibiotic therapy (n=197; 40.7%), an inadequate spectrum of activity, i.e. too broad, (n=95; 19.62%), and excessive treatment duration (n=87; 17.97%). Rates of inadequate prescriptions were 82.26% for ENT infections, 71.2% for cutaneous infections, 46.53% for respiratory tract infections, and 38.4% for urinary tract infections.
  
  
  CONCLUSIONS
  Antibiotic prescriptions written to outpatients in the emergency department are often inadequate. Enhancing prescribers' training and handing out guidelines is therefore necessary. The quality of these prescriptions should then be re-assessed.
authors.affiliation: Service des urgences, hôpital Ambroise-Paré, hôpital universitaire Paris-Île-de-France-Ouest, AP-HP, UVSQ, 92100 Boulogne-Billancourt, France.
authors.forename: J
authors.initials: J
authors.lastname: Grenet
authors.affiliation: Service des maladies infectieuses et tropicales, hôpital R.-Poincaré, hôpitaux universitaires Paris-Île-de-France-Ouest, AP-HP, UVSQ, 92380 Garches, France.
authors.forename: B
authors.initials: B
authors.lastname: Davido
authors.affiliation: Pharmacie, hôpital R.-Poincaré, Paré, hôpital universitaire Paris-Île-de-France-Ouest, AP-HP, UVSQ, 92380 Garches, France.
authors.forename: F
authors.initials: F
authors.lastname: Bouchand
authors.affiliation: Laboratoire de microbiologie, hôpital Ambroise-Paré, hôpital universitaire Paris-Île-de-France-Ouest, AP-HP, UVSQ, 92100 Boulogne-Billancourt, France.
authors.forename: V
authors.initials: V
authors.lastname: Sivadon-Tardy
authors.affiliation: Département d'informatique médical, hôpital Ambroise-Paré, hôpital universitaire Paris-Île-de-France-Ouest, AP-HP, UVSQ, 92100 Boulogne-Billancourt, France.
authors.forename: A
authors.initials: A
authors.lastname: Beauchet
authors.affiliation: Pharmacie, hôpital Ambroise-Paré, hôpital universitaire Paris-Île-de-France-Ouest, AP-HP, UVSQ, 92100 Boulogne-Billancourt, France.
authors.forename: T
authors.initials: T
authors.lastname: Tritz
authors.affiliation: Service des urgences, hôpital Ambroise-Paré, hôpital universitaire Paris-Île-de-France-Ouest, AP-HP, UVSQ, 92100 Boulogne-Billancourt, France.
authors.forename: C
authors.initials: C
authors.lastname: Guyot
authors.affiliation: Service des maladies infectieuses et tropicales, hôpital R.-Poincaré, hôpitaux universitaires Paris-Île-de-France-Ouest, AP-HP, UVSQ, 92380 Garches, France.
authors.forename: C
authors.initials: C
authors.lastname: Perronne
authors.affiliation: Service des maladies infectieuses et tropicales, hôpital R.-Poincaré, hôpitaux universitaires Paris-Île-de-France-Ouest, AP-HP, UVSQ, 92380 Garches, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Gaillard
authors.affiliation: Service des maladies infectieuses et tropicales, hôpital R.-Poincaré, hôpitaux universitaires Paris-Île-de-France-Ouest, AP-HP, UVSQ, 92380 Garches, France.
authors.forename: J
authors.initials: J
authors.lastname: Salomon
authors.affiliation: Service des urgences, hôpital Ambroise-Paré, hôpital universitaire Paris-Île-de-France-Ouest, AP-HP, UVSQ, 92100 Boulogne-Billancourt, France.
authors.forename: S
authors.initials: S
authors.lastname: Beaune
authors.affiliation: Service des maladies infectieuses et tropicales, hôpital R.-Poincaré, hôpitaux universitaires Paris-Île-de-France-Ouest, AP-HP, UVSQ, 92380 Garches, France. Electronic address: aurelien.dinh@aphp.fr.
authors.forename: A
authors.initials: A
authors.lastname: Dinh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy; D017714:Community-Acquired Infections / Q000188:drug therapy; D003953:Diagnosis-Related Groups; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D004636:Emergency Service, Hospital; D005260:Female; D005602:France; D019983:Guideline Adherence; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial stewardship; Bon usage des antibiotiques; Community-acquired infections; Infections communautaires; Infectious disease specialist; Référent