The following is a summary of “Implementation of indication-based antibiotic order sentences improves antibiotic use in emergency departments,” published in the July 2023 issue of Emergency Medicine by Vuong et al.

Prior research suggests that suboptimal antibiotic prescribing in the emergency department (ED) is prevalent for uncomplicated lower respiratory tract infections (LRTI), urinary tract infections (UTI), and acute bacterial skin and skin structure infections (ABSSI). This study aimed to assess the impact of indication-based antibiotic order sentences (AOS) on optimal antibiotic prescribing in the emergency department. Adults prescribed antibiotics in EDs for uncomplicated LRTI, UTI, or ABSSSI from January to June 2019 (pre-implementation) and September to December 2021 (post-implementation) were part of a quasi-experiment approved by the Institutional Review Board.

The AOS was implemented in July 2021. AOS are electronic prescriptions for discharge that are retrievable by name or indication in the discharge order field. The primary outcome was optimal prescribing, defined as the correct selection, dose, and duration of antibiotics according to local and national guidelines. Descriptive and bivariate statistics were calculated, and multivariate logistic regression was employed to identify variables associated with optimal prescribing. There were 294 patients: 147 in the pre-group and 147 in the post-group. 

Overall, optimal prescribing increased from 8% to 23% (P<  0.001). Individual components of optimal prescribing were optimal selection at 90 (61%) versus 117 (80%) (P<  0.001), optimal dose at 99 (67%) versus 115 (78%) (P= 0.036), and optimal duration at 38 (26%) versus 50 (34%) (P = 0.13), for the pre-and post-groups, respectively. In a multivariable logistic regression analysis, AOS was independently associated with optimal prescribing (adjusted odds ratio [aOR], 3.60; 95% CI, 1.70–7.2]. A post-hoc analysis revealed minimal AOS prescribing by ED physicians. AOS is an effective and prospective strategy for improving antimicrobial stewardship in the emergency department.

Source: sciencedirect.com/science/article/abs/pii/S0735675723001638