Appropriateness of antibiotic use in the emergency department: A five-year retrospective study in a region with high antibiotic consumption.

BACKGROUND

We aimed to evaluate the use of antibiotics for upper respiratory tract infections (URTIs), particularly during the COVID-19 pandemic in an emergency department (ED), by assessing adherence to the clinical pathway implemented seven years ago.

METHODS

We performed a retrospective study from 2018 to 2022 and included patients with URTIs only in April and November of each year to control for temporal bias.

RESULTS

A total of 1,683 patients with URTIs were included. We found that 242 of 1,683 (14.3%) patients were administered or prescribed antibiotics in the ED, and 214 of 1,683 (12.7%) had clinical pathway non-adherence. Of the 242 patients, 136 (56.2%) were female, and the mean age was 37.8 (SD: 0.94). The most frequent diagnoses were acute tonsillopharyngitis (55%) and cold/non-specific URTIs (38.4%), respectively. The Streptococcus pyogenes rapid antigen test was positive in 23 of 133 (17.2%) patients with acute tonsillopharyngitis, and 4 of 133 patients had a 4-point Centor score. The first choice of antibiotics was beta-lactams. In multivariate analysis, the predictors of appropriate antibiotic use among patients were acute tonsillopharyngitis (OR: 17.8, CI 3.96-80.1, p < 0.001) and rapid S. pyogenes antigen positivity (OR: 11.7, CI 3.9-23.7, p < 0.001).

CONCLUSIONS

Despite the global inappropriate use of antibiotics during the COVID-19 pandemic, our study observed a decline in non-adherence to clinical pathways and antibiotic use in URTIs from 2020 to 2022, likely due to increased awareness among ED physicians and the impact of educational programs. Long-term success will require ongoing training, feedback, and updates for ED physicians.