Background: Inappropriate Antibiotic (ATB) prescription threatens patients with adverse drug reactions, bacterial resistance, and subsequently elevated hospital costs. Aim was to evaluate ATB prescriptions in an Emergency Department (ED) at tertiary care facility.
Methods: A cross-sectional study was conducted by chart-reviewing patients with infectious complaints. Patient characteristics (age, gender, weight, allergy, infection type) and prescription characteristics (class, dose, frequency, duration) were evaluated for appropriateness based on two internationally recognized drug guidebooks. Descriptive and analytic statistics were applied.
Results: Sample with equal gender distribution constituted of 5752 cases: adults (61%) & pediatrics (39%). Around (55%) complained respiratory tract infections (RTIs), (25%) urine tract infections (UTIs), and (20%) others. Broad spectrums were prescribed for (77%) of the cases. Prior prescription in pediatrics, (82%) had weight taken, while (8%) had allergy screening. Prevalence of ATB prescriptions with at least one type of error was (58%) in pediatrics and (39%) in adults. Errors were: ATB class selection (2%), Dosage (21%), Frequency (6%), and Duration (25%). Dosage & duration errors were significantly predominant among pediatrics (p=0.0001 & p<0.0001 respectively). Selection error was higher among adults (p=0.002). Age stratification and binary logistic regression were applied. Significant predictors of errors in both age groups were associated with: 1) Penicillin prescriptions: (adult: p<0.001, adj.OR=3.09), (pediatrics: p<0.001, adj.OR=4.10) compared to cephalosporin, 2) RTIs (adults: p<0.001, adj.OR=2.82), (pediatrics: p=0.039, adj.OR=1.37) compared to UTIs, 3) Obtaining weight for pediatrics prior prescription (p<0.001, adj.OR=1.83) compared to those who didn’t.
Conclusions: Prevalence of ATB prescription errors in this ED was alerting. Drug guidebooks need to be more accessible. Consulting of infection experts and screening for allergies/weight prior prescriptions is highly recommended.