The importance of antibiotic stewardship is well known to all of us given the rising rates of antibiotic resistance globally. One of the most common places to prescribe antimicrobial agents is in emergency departments (EDs)—but just how well are we doing in curtaining the use of antibiotic prescribing especially when the clinical condition does not suggest they are really warranted. This is what Poole et al. (10.1542/peds.2018-1056) set out to discover with a cross-sectional retrospective study of children and teens ages 0-17 discharged from emergency departments about the US according to data from the National Ambulatory Care Survey. The authors report on 29 million Emergency Department (ED) visits per year between 2009 and 2014 in both pediatric and non-pediatric EDs. If you think the trends over those five years show a decline over time, think again. Trends were stable but most notably, non-pediatric EDs versus pediatric EDs were more likely to prescribe antibiotics for non-indicated situations. These non-pediatric EDs also were more apt to prescribe macrolides, (18% vs 8%) and less likely to use evidence-based guidelines for prescribing (or not) with the respiratory conditions studied.
What can we do about this? We asked Emergency Medicine physicians Drs. Rakesh Mistry, Larissa May, and Michael Pulia to share with us their thoughts in an accompanying commentary (10.1542/peds.2018-2972). They point out that over 80% of pediatric emergency care takes place in non-children’s hospital EDs that lack specialists trained in pediatric emergency medicine. They offer a number of strategies to improve antibiotic stewardship in all types of EDs that care for children including closer collaboration between children’s hospital and non-children’s hospital EDs, incorporation of evidence-based stewardship guidelines into electronic health records, and other ideas that warrant your emergent attention along with the anchor study. If you don’t work in an ED, be a good steward and feel free to share this article and commentary with those who do—especially if they work in a non-children’s hospital ED.