Antibiotic Stewardship in the Emergency Department: Raising the Bar for Antibiotic Use

From Medscape (registration required):

The growing incidence of antibiotic- resistant bacteria andClostridium difficile colitis is a problem in hospitals across the world. To combat this situation, efforts are being made to curtail unnecessary use of antibiotics. To date, most efforts have focused on inpatient care units and outpatient clinics. Little attention has been paid to the emergency department (ED).

The ED differs from inpatient care units primarily in the need for rapid patient turnaround. Clinical decisions are often based on preliminary laboratory results. Microbiology testing results are seldom available when care is rendered. ED physicians are ever vigilant for errors of omission, because “we only get 1 shot at the patient” and are chary about the risk for litigation from missing a diagnosis of infection.

ED physicians may be less concerned about adverse effects of antibiotics because follow-up with treated patients is limited. Thus, antibiotics are often used liberally in the ED. With a greater awareness of current treatment guidelines for selected conditions and with use of the procalcitonin (PCT) test to help rule out bacterial infection, antibiotic use in the ED can be curtailed with a salutary effect on patient outcomes.

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