[A prospective study of antibiotic prescribing in an emergency care unit]

The aim of the study was to assess the quality of the initial prescription of antibiotics in an emergency care unit (ECU).

A two-week prospective observational study was performed in the ECU Ambroise-Paré covering all patients that were given antibiotic prescriptions. The antibiotic treatments were reviewed by medical experts and confronted with the recommendations of the local guide to antibiotic protocols (referential). Treatments were considered appropriate if indication, choice of the molecule, and route of administration complied to protocols; unacceptable if the indication or the choice of antibiotic was incorrect; debatable in all other cases.

One hundred and four patients were reviewed over the two-week period. Treatments were prescribed mainly for urinary infections (31 cases), pulmonary (26) or cutaneous (23). In 84.5% of cases, indication was present in the referential. Beta-lactams accounted for 60% of prescriptions, followed by fluoroquinolones (32.5%). By combining three criteria (indication, choice and route of administration), only 54% of prescriptions were considered appropriate, 31% were debatable, and 15% unacceptable. Analysis showed that the quality of antibiotherapy was significantly better if the prescriber was informed about the inquiry and if the indication was present in the guidelines.

The antibiotherapy manual is an indispensable tool for prescribers in the ECU, but it is insufficient to guarantee the quality of antibiotic prescriptions. Training sessions must be set up for emergency doctors, and the intervention of an infectious diseases specialist, as well as discussions about repeated clinical audit results, should enable a better use of antibiotics in the emergency unit.