Factors Determining the Appropriateness of Ceftriaxone
Usage at the Emergency Room of a University Hospital
in Thailand
Angsana Phuphuakrat MD, PhD*,
Sasisopin Kiertiburanakul MD, MHS*, Kumthorn Malathum MD*
Affiliation :
* Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Ceftriaxone is one of the most common empirical antibiotics prescribed at emergency rooms in Thailand.
Inappropriate prescriptions of antibiotics have been frequently reported. The authors aimed to study factors that determine
the appropriateness of ceftriaxone usage at an emergency room of a university hospital in Thailand.
Material and Method: A cross-sectional study was conducted among patients with age of >15 years old who received
ceftriaxone as empirical treatment at the emergency room between April 1 and May 31, 2010. Appropriateness of ceftriaxone
usage was considered according to local recommendations and current published guidelines.
Results : During the 2-months period, 278 patients for whom ceftriaxone was prescribed were included in the analysis. Of
these, 109 (39.2%) were men and a median (interquartile range; IQR) age of 62.2 (45.2-75.7) years. Ceftriaxone usage
was considered appropriate in 162 (58.3%) cases. By multiple logistic regression, female gender [odds ratio (OR) 1.96,
95% confidence interval (CI) 1.03-3.70], fever (OR 3.12, 95% CI 1.3-6.11), had signs and symptoms of infections (OR 2.92,
95% CI 1.37-6.28), and suspicion of sepsis (OR 7.90, 95% CI 3.67-17.07), were associated with appropriateness of ceftriaxone
usage, while diagnosis of gastrointestinal tract infection was associated with inappropriate ceftriaxone usage (OR 0.20,
95% CI 0.05-0.77).
Conclusion : Proportion of appropriate use of ceftriaxone is fair. As assessed by established criteria, clinical suspicion of
infection was associated with appropriateness of ceftriaxone usage for empirical treatment in an emergency room setting.
Interventions to improve appropriateness of ceftriaxone prescription should focus on these factors.
Keywords : Antibiotic, Appropriateness, Ceftriaxone, Emergency room
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