Ceftriaxone use in the emergency department: are we doing it right?
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Published on: November 9, 2016
1Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA. shabnam_jain@oz.ped.emory.edu
Insights
Ceftriaxone use in pediatric emergency departments is frequently not justified by guidelines. This study found overuse in 63.7% of initial visits and 66.4% overall for febrile infants.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Antibiotic Stewardship
Background:
- Ceftriaxone is a commonly used antibiotic in pediatric emergency departments (PEDs).
- Published guidelines exist for the appropriate management of febrile infants to prevent overuse.
- Evaluating current prescribing patterns is crucial for antibiotic stewardship.
Purpose of the Study:
- To assess the patterns of ceftriaxone administration in an urban pediatric emergency department.
- To determine the extent of ceftriaxone overuse based on established clinical guidelines for febrile infants.
Main Methods:
- A retrospective analysis of 229 febrile patients (aged 3 months to 18 years) who received ceftriaxone was conducted.
- Exclusion criteria included patients younger than 3 months, those with chronic illnesses, and treatment for sexually transmitted diseases.
- Data were stratified by age, fever source, temperature, leukocyte count, pneumonia diagnosis, and visit order.
Main Results:
- Ceftriaxone was administered 289 times to 229 patients during the study period.
- Antibiotic use was justified in only 17.5% of initial visits and 16.6% of all encounters.
- Overuse was identified in 63.7% of initial visits and 66.4% of all encounters, with similar rates for repeat administrations.
Conclusions:
- Ceftriaxone prescribing in the studied pediatric emergency department frequently deviates from published guidelines.
- A significant majority of ceftriaxone administrations were deemed not justified, indicating potential overuse.
- Findings highlight the need for improved antibiotic stewardship and adherence to guidelines in pediatric settings.
Objective:
To evaluate the patterns of ceftriaxone use in an urban pediatric emergency department (PED) and to determine if overuse exists based on published guidelines for management of febrile infants.
Methods:
We conducted a retrospective study of 229 young febrile patients who received ceftriaxone between January 1 and March 31, 1995, in a large urban PED in a teaching hospital in Atlanta. Patients younger than 3 months, patients with chronic illnesses (eg, sickle cell anemia, HIV), and those who received ceftriaxone for sexually transmitted diseases were excluded.
Results:
During the study period, ceftriaxone was administered 289 times to 229 patients (53% male) aged 3 months to 18 years. Sixty patients (26%) received ceftriaxone two or more times for the same illness. Data were stratified based on age, source of fever, temperature, leukocyte count, diagnosis of pneumonia, and visit order (initial or follow-up). At the time of their initial visit, 180 of 229 patients had an identifiable focus of infection (76 had pneumonia), but no source could be identified in the remaining 49. Based on temperature, leukocyte count, and the presence or absence of a focus, ceftriaxone use, as compared with practice guidelines, was justified in 40 of 229 (17.5%) patients, questionable in 43 of 229 (18.8%), and not justified in 146 of 229 (63.7%). For the 60 patients who received ceftriaxone more than once, its use was justified in only 13%. Results of blood cultures were positive in 3 of 229 (1.3%) patients. Ceftriaxone was justified according to published guidelines in two of these three patients, whereas one patient with pneumonia and pneumococcal bacteremia could have been treated with oral antibiotics. Overall, for the entire study population (289 encounters at initial and subsequent visit combined), ceftriaxone use was justified in 48 patients (16.6%), questionable in 49 patients (17%), and not justified in 192 patients (66.4%).
Conclusions:
Based on published guidelines, ceftriaxone use in the PED was not justified in the majority of cases.
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