Impact of antibiotic post-prescription authorization in resource-limited emergency rooms and acute care units during the COVID-19 pandemic
Issued Date
2025-10-09
Resource Type
eISSN
1471227X
Scopus ID
2-s2.0-105018270414
Pubmed ID
41068654
Journal Title
BMC Emergency Medicine
Volume
25
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMC Emergency Medicine Vol.25 No.1 (2025) , 202
Suggested Citation
Kingsuvangul N., Boonchaikamonarkorn W., Rattanaumpawan P. Impact of antibiotic post-prescription authorization in resource-limited emergency rooms and acute care units during the COVID-19 pandemic. BMC Emergency Medicine Vol.25 No.1 (2025) , 202. doi:10.1186/s12873-025-01363-0 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/112640
Title
Impact of antibiotic post-prescription authorization in resource-limited emergency rooms and acute care units during the COVID-19 pandemic
Author's Affiliation
Corresponding Author(s)
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Abstract
BACKGROUND: Antimicrobial overuse is a major problem in various healthcare settings, including emergency rooms (ERs) and acute care units (ACUs). This study aimed to evaluate the impact of the post-prescription authorization (PPA) of antibiotics in these settings. METHODS: This retrospective observational study included ER and ACU patients at Siriraj Hospital. In August 2020, a PPA for piperacillin/tazobactam, meropenem, imipenem/cilastatin, and ertapenem was implemented. These antibiotics were unrestricted for the first 72 h; thereafter, infectious disease physician approval was required. Data from pre-implementation (July 2020) and post-implementation (September 2020) periods were compared. RESULTS: Two-hundred and six patients were included in the study (103 patients each from the pre- and post-implementation periods). There were no significant differences between the groups regarding male sex (49.5% vs. 47.6%;p = 0.78) and age (67.63 ± 22.9 vs. 66.94 ± 17.4 years;p = 0.27). The respiratory tract was the most common infection site, and piperacillin/tazobactam was the most frequently first-prescribed antibiotic. Using too narrow-spectrum antibiotics was the most common reason for inappropriate antibiotic use. The day of therapy/outpatient-day of the target antibiotics was significantly lower in the post-implementation group (0.85 ± 0.41 vs. 0.72 ± 0.39;p = 0.02). Favorable clinical outcomes were significantly higher in the post-implementation group (42.7% vs. 62.1%;p = 0.005). CONCLUSIONS: This study demonstrates the positive impact of PPA in emergency settings, with a 15% reduction in antibiotic consumption and a 20% increase in favorable clinical outcomes. Future studies should evaluate PPA early in the course of treatment to identify the most effective interventions for improving the quality of care.