Intended for healthcare professionals


Antibiotics account for 19% of emergency department visits in US for adverse events

BMJ 2008; 337 doi: (Published 15 August 2008) Cite this as: BMJ 2008;337:a1324
  1. Bob Roehr
  1. 1Washington, DC

    Adverse events associated with antibiotics result in more than 142 000 visits a year to hospital emergency departments in the United States. The drugs were implicated in 19% of all emergency department visits for drug related adverse events.

    The rate of 10.5 emergency department visits per 10 000 outpatient prescriptions of antibiotics “was higher than expected,” says the paper in Clinical Infectious Diseases (doi: 10.1086/591126). That was about half the rate of events attributed to “high risk” drugs such as warfarin, insulin, and digoxin (20.6 visits per 10 000 prescriptions), the authors write.

    The rate among infants aged 12 months old or younger was 50% greater than the overall figure, at 15.9 visits per 100 000 prescriptions.

    The study, conducted by the US Centers for Disease Control and Prevention, drew on data from 63 representative hospital sites across the country in 2004-6 and on prescription data from comprehensive national surveys of healthcare facilities.

    Penicillins were implicated in 37% of the adverse events and cephalosporins in 12%.

    Nearly 80% of the visits were for allergic reactions, while adverse events associated with other classes of drugs were more likely to be due to medication errors and overdoses. The paper noted that most allergic reactions can be prevented only by avoiding exposure to the drug. People aged 15-44 years accounted for 41% of the visits and infants 12 months old or younger for 6.3%.

    Emergency department visits were half as likely again among female patients than among male patients (12.5 versus 7.9 visits per 100 000 prescriptions). This difference might be due to the effect of women’s lower body mass on drug concentrations and metabolism or to greater reticence of men to seek medical attention, the authors say.

    John Bartlett, a specialist in infectious diseases at Johns Hopkins University, Baltimore, said that about 75% of prescriptions of antibiotics are for respiratory tract infections. He said, “Acute bronchitis is virtually never a bacterial infection and is one of the big sources of antibiotic abuse. About 70% who see a physician get a prescription.”

    Antibiotics are overprescribed for other types of respiratory tract infections too, Dr Bartlett said. Besides the adverse reactions that may result from use of antibiotics, he added, they often don’t work, increase resistance among pathogens, and add unnecessary costs to the healthcare system and to patients.

    “Part of the problem [in the US] is cultural,” he said. “People are used to getting antibiotics for a bad cold, so they expect [a prescription]. They don’t seem to expect them or get them in the Netherlands, which may be the reason that resistance is so incredibly low in that country.

    “The data show that antibiotic usage is about three times more frequent [in terms of the number of daily doses per person] in France compared to the Netherlands, and resistance rates are much higher in France.”


    Cite this as: BMJ 2008;337:a1324

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