BackgroundAntibiotics represent one of the most prescribed therapeutic agents in the Emergency Department (ED). It is considered that 26% to 62% of outpatient antibiotic prescriptions are made in this area. About 30% to 50% of these prescriptions are inappropriate.PurposeTo assess the appropriateness of antibiotic prescriptions in the ED of a tertiary hospital to conform to the local empirical antibiotic treatment guidelines.Material and methodsObservational, retrospective study including patients who attended the ED, during November 2016, with an antibiotic prescription. To assess the appropriateness of antibiotic prescriptions, they were compared to local empirical antibiotic treatment guidelines. Data were collected from the medical records of patients.ResultsSix hundred and seventy-six patients were included, 386 females (57. 1%), mean age 47.4±21.2 years. Patients’ diagnoses were: 27.2% (184) urinary tract infections (UTI), 24.1% (163) lower respiratory tract infections, 15.4% (104) skin and soft tissue infections (SSTI), 13.8% (93) upper respiratory tract infections, 11.8% (80) oral infections, 2.7% (18) genital and sexually transmitted infections, 1.6% (11) gastrointestinal infections, 0.3% (two) ocular infections and 3.1% (21) other (where there were no registers of infection or could not be categorised in any of the previous locations). The most prescribed antibiotic families were: 44.1% (298) penicillins, 21.3% (144) fluoroquinolones, representing more than 60% of all antibiotic prescriptions. The most prescribed antibiotics by location were: fosfomycin trometamol in UTI (32.1%), levofloxacin in lower respiratory tract (46.2%) y amoxicillin/clavulanate in upper respiratory tract (46.6%), SSTI (62.5%) and oral infections (71.6%). In 56.8% (384) of the prescriptions, the use of an antibiotic drug was indicated. Nevertheless, the appropriate antibiotic was selected only in 62% (238) of the prescriptions. An appropriate dosage and duration of antibiotic treatment was selected in 828% (197) and 45.4% (108) of the prescriptions, respectively. In 22.9% and 35.1% of the analysed episodes, patients required previous or subsequent medical assistance.ConclusionAppropriateness of antibiotic prescriptions was low. Noncompliance was mainly due to an overuse of antibiotics when not indicated, incorrect treatment duration and overuse of broad spectrum antibiotics. The need for subsequent medical assistance could be related to treatment failure. These data reinforce the need to develop an antimicrobial stewardship programme in the ED, where emergency medicine pharmacists could be decisive in influencing inappropriate antimicrobial use and by enhancing adherence to local empirical antibiotic treatment guidelines.No conflict of interest

ObjectivesTo study the adherence to biologic therapy (BT) of patients with RA.MethodsDesign: Cross-sectional study. Patients: 40 RA-pts treated with BT (50% wit subcutaneously [sc] and 50% with intravenously [iv]) with or without synthetic DMARDs were consecutively recruited from a specific unit of BT. Protocol: Patients with sc BT are alternately reviewed every three months in general and specific (only BT pts) outpatient clinic. Iv BT patients are checked each time the drug is infused. At 5 days from 1st iv BT infusion or in the day that 2nd dose of sc BT is given, patients receive a call from the nurse to confirm that everything went well. Patients with sc BT have a self-injections diary and direct free telephone access to the nurse. Variables: Demographic, clinical and laboratory, therapeutic, Morisky-Green adherence questionnaire (MGAQ), control of the number of sc BT doses withdrawn from outpatient hospital pharmacy, assisting to infusions in the case of iv BT and removal of synthetic DMARDs in the drugstores using “XXI electronic prescription” (a software used to control the dispensations in the public health system in Andalusia) in the last 6 months. Outcome variables: (1) level of adherence and (2) compliance level with MGAQ. MGAQ considers that the patients are adherents when they give 3 or more responses indicative of adherence. Good drug withdrawal from hospital pharmacy or drugstore was defined as removal of >80% of the prescribed dose. Adherence to BT and synthetic DMARDs was measured independently. The degree of adhesion was classified as good (3 or 4 correct responses in MGAQ and good drug withdrawal), medium (3 or 4 good responses in MGAQ but bad drug withdrawal or vice versa) and bad (<3 good responses in MGAQ and bud drug withdrawal). Statistical analysis: Descriptive analysis of the main variables. Adherence between sc BT and iv BT was compared using T-Student.ResultsThe main characteristics of the patients (n=40) are shown in the table. 10/40 patients were in monotherapy. 37/40 (92.5%) showed good adherence to BT, 3/40 (7.5%) moderate and bad none. There was no difference in the level of adherence to BT among sc BT and iv. BT (90% vs. 95% good adhesion; p=0.50) nor between BT alone or in combination with DMARDs (70% vs. 100% good adhesion; p=0.12). The level of adherence was good with BT in 100% of the patients and in the 70% with synthetic DMARDs.Table 1.Demographic-clinical featuresVariablesPatientsAge (years), mean (DE)57,1 (9,3)Sex (Female), n (%)32 (80)Race (Caucasian), n (%)38 (95)Rheumatoid factor, n (%)35 (87,5)Anti–cyclic citrullinated peptide, n (%)33 (82,5)Erosions, n (%)32 (80)DAS28 at protocol, mean (DE)2,9 (0,9)HAQ at protocol, mean (DE)1,1 (0,6)Delay to diagnosis (months), mean (DE)21,9 (2,34)Disease duration (months), mean (DE)138,8 (6,4)ConclusionsAdherence to BT in RA-patients in a specific unit of BT that controls the treatment adherence is very good with the BT and good with synthetic DMARDs. Patients treated with sc or iv. BT and those with monotherapy or combination thera...