Top 10 Antibiotic Mistakes in the Emergency Department

Overview:  Ever feel lost and confused when it comes to antibiotic choice? Feel like you are making a mistake by giving this instead of that? Giving too much? Giving too little? If so, you’re not alone. So let's branch out from just vanc and zosyn and dive into the top 10 antibiotic mistakes today with pharmacy guru Dr. Bryan Hayes.

Take-home points:

• When it comes to antibiotic allergies listed in the chart, always talk and confirm with the patient
• Don’t be afraid to try PO meds before rushing for the IV version
• Consider other options before going for the one-time dose of IV Vancomycin, however if you do use IV Vanc, don’t be afraid to give a big dose
• When it comes to broad-spectrum coverage in sick neutropenic or septic shock patients, consider doubling up gram-negative coverage
• Use your drug references to find dosing ranges, but in the ED, go big and pick the higher dose (especially for critically ill and larger patients)
• Don’t forget to look at a patient’s medical history to see if they have had cultures before, and see what the susceptibilities were in the past.
• We see a LOT of pop-ups with medication warnings, some of which don’t mean much, however there are some drug interactions that should be taken seriously, especially with fluoroquinolones.
• ED pharmacists are your friends. They are there to be a resource, utilize them!

Resources

1. Levine BJ. EMRA Antibiotic Guide. Emergency Medicine Residents’ Association; Dallas, Texas:2022.
2. Maguire M, Hayes BD, Fuh L, et al. Beta-lactam antibiotic test doses in the emergency department. World Allergy Organ J. 2020;13(1):100093.
3. Rosini JM, Laughner J, Levine BJ, Papas MA, Reinhardt JF, Jasani NB. A randomized trial of loading vancomycin in the emergency department. Ann Pharmacother. 2014;49(1):6-13.