Prevalence and predictors of antibiotic prescription errors in an emergency department, Central Saudi Arabia

Abstract

Menyfah Q Alanazi,1 Majed I Al-Jeraisy,2,3 Mahmoud Salam2 1Drug Policy and Economic Center, 2King Abdullah International Medical Research Center (KAIMRC), 3King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia Background: Inappropriate antibiotic (ATB) prescriptions are a threat to patients, leading to adverse drug reactions, bacterial resistance, and subsequently, elevated hospital costs. Our aim was to evaluate ATB prescriptions in an emergency department of a tertiary care facility. Methods: A cross-sectional study was conducted by reviewing charts of patients complaining of infections. Patient characteristics (age, sex, weight, allergy, infection type) and prescription characteristics (class, dose, frequency, duration) were evaluated for appropriateness based on the AHFS Drug Information and the Drug Information Handbook. Descriptive and analytic statistics were applied. Results: Sample with equal sex distribution constituted of 5,752 cases: adults (15 years) =61% and pediatrics (<15 years) =39%. Around 55% complained of respiratory tract infections, 25% urinary tract infections (UTIs), and 20% others. Broad-spectrum coverage ATBs were prescribed for 76% of the cases. Before the prescription, 82% of pediatrics had their weight taken, while 18% had their weight estimated. Allergy checking was done in 8% only. Prevalence of inappropriate ATB prescriptions with at least one type of error was 46.2% (pediatrics =58% and adults =39%). Errors were in ATB selection (2%), dosage (22%), frequency (4%), and duration (29%). Dosage and duration errors were significantly predominant among pediatrics (P<0.001 and P<0.0001, respectively). Selection error was higher among adults (P=0.001). Age stratification and binary logistic regression were applied. Significant predictors of inappropriate prescriptions were associated with: 1) cephalosporin prescriptions (adults: P<0.001, adjusted odds ratio [adj OR] =3.31) (pediatrics: P<0.001, adj OR =4.12) compared to penicillin; 2) UTIs (adults: P<0.001, adj OR =2.78) (pediatrics: P=0.039, adj OR =0.73) compared to respiratory tract infections; 3) obtaining weight for pediatrics before the prescription of ATB (P<0.001, adj OR =1.83) compared to those whose weight was estimated; and 4) broad-spectrum ATBs in adults (P=0.002, adj OR =0.67). Conclusion: Prevalence of ATB prescription errors in this emergency department was generally high and was particularly common with cephalosporin, narrow-spectrum ATBs, and UTI infections. Keywords: antibiotic, prescription, errors, prevalence, predictors, emergency