Aims
The proper use of antibiotics is essential in the elderly. Prescription is often initiated in the Emergency Department (ED). The aim of our study was to estimate the higher number of prescriptions of antibiotics in the elderly in the ED, taking the example of the amoxicillin/clavulanic acid (Ax/Ac), the most prescribed antibiotic in French hospitals.
Procedure
Retrospective study between January and November 2012 in the ED of Henri Mondor Universitary Hospital, Paris region, France. All patients who received Ax/Ac were included and divided in two groups (young <75 years and elderly ≥75 years), and then compared.
Results
During the study period, 41,638 patients were admitted to the ED. Among them, 6,669 were older than 75 years (16.0 %) and 571 received Ax/Ac (1.4%). Ax/Ac prescription was 5 times higher in the elderly than in the young (OR 5.2, 95% CI 4.4-6.2, p<0.001): 284 prescriptions in the elderly (49.7% of Ax/Ac prescriptions and 4.3% of the elderly patients) and 287 in the young (50.3% of Ax/Ac prescriptions and 0.7% of young adults). Female gender, respiratory infections, leukocytosis and hospitalization were significantly more frequent in elderly, while prophylaxis use was more common in young people.
Conclusion
There is a higher prescription of Ax/Ac in elderly patients. This is likely explained by the higher frequency of respiratory tract infections, multiple comorbidities and the difficulties of diagnosis of infection in this population, especially in the ED. First line antibiotic regimen must be particularly rigorous in the elderly to avoid unnecessary or inappropriate antibiotic therapy, treatment failure and emergence of resistance.