Factors influencing ceftriaxone use in community‐acquired pneumonia: Emergency doctors’ perspectives

Abstract

As most cases of CAP are initially diagnosed and treated empirically in the ED, any interventions that aim to decrease inappropriate use of ceftriaxone for CAP should address the factors identified here that influence ED doctors' prescribing decisions.

Antimicrobial stewardship in Australian emergency departments

“…Challenges to the implementation of AMS in the ED have been described and include: ‘rapid patient turnover, speed of decision making with incomplete available diagnostic data, large volume of staff, perceived patient expectations of the need for antimicrobials, lack of access to follow up for ED patients and prescribing patterns of colleagues’. Many similar factors influence the choice of ABs in the ED as well as the prescriber's prior experience and source of AB guidance …”

“…Many similar factors influence the choice of ABs in the ED as well as the prescriber's prior experience and source of AB guidance. 9 Mobile phone technology is commonly used by ED doctors to access drug information. 10 In one study, 89% of ED doctors were found to use such a device for AB prescribing decisions.…”

Retrospective audit of antimicrobial prescribing practices for acute exacerbations of chronic obstructive pulmonary diseases in a large regional hospital

“…Significantly more patients treated with ceftriaxone compared to a non-ceftriaxone-based regimen (45Á5% Oxygen saturations of at least 88% were considered acceptable in this population. 16 vs. 8Á9%; P = 0Á002) had growth of upper respiratory tract flora with no pathogens isolated reported. The most commonly isolated pathogens from sputum were H. influenzae (n = 11), Pseudomonas (n = 7), M. catarrhalis (n = 6) and S. pneumoniae (n = 3).…”

“…This is because patients in ceftriaxone group have higher temperature, and higher values of other severity determining parameters such as WBC, CRP and BAP‐65 values. Despite the fact that patients were excluded if they have radiological evidence of pneumonia, sicker patients received ceftriaxone that is commonly used for pneumonia, albeit inappropriately in that indication as well . Clinicians' perceptions of a patient's severity of disease are noted as an important determinant of inappropriate prescribing .…”

“…Despite the fact that patients were excluded if they have radiological evidence of pneumonia, sicker patients received ceftriaxone that is commonly used for pneumonia, albeit inappropriately in that indication as well. 16 Clinicians' perceptions of a patient's severity of disease are noted as an important determinant of inappropriate prescribing. 17 Higher CRP values and all the other clinical parameters in the absence of radiological evidence of pneumonia in COPD patients are classified as AECOPD, and therefore, these patients should not be receiving broad-spectrum antibiotics like ceftriaxone as per the national guidelines.…”