Study: ED asthma patients get needless antibiotics

Acute asthma patients often are given unnecessary antibiotics in the ED, according to new research. Researchers used data from the National Hospital Ambulatory Medical Care Survey and the National Emergency Department Safety Study and found that about 20% of acute asthma visits resulted in an antibiotic prescription.1

While some of these may have been appropriate, most were probably not. "It's very unlikely that one in five ED patients with acute asthma actually needs an antibiotic," says Carlos Camargo, MD, one of the study's authors and an ED physician at Massachusetts General Hospital in Boston. "Emergency nurses should remember this."

ED treatment of acute asthma with unnecessary antibiotics is likely to contribute to bacterial antibiotic resistance, he warns Camargo.

"Current asthma guidelines, in countries, do not recommend antibiotic treatment for asthma exacerbations," Camargo says. These include the updated 2007 asthma guidelines from the National Institutes of Health.2

Camargo recommends "lowering patient expectations for prescription of an antibiotic at the outset" by explaining that viruses do not respond to antibiotics. "The important thing to remember is that there are other, much more effective ways to improve emergency asthma care."

When in doubt, ask

If you believe that an ED physician could be prescribing antibiotics inappropriately, ask why they're being prescribed. "Remember that some antibiotic prescriptions will be appropriate. Often, however, the prescription will not be indicated," says Camargo.

Antibiotics are prescribed appropriately for asthma when it is deemed that a bacterial infection most likely has precipitated the exacerbation, says Jennifer Cochran, RN, patient care manager for the ED at Cox South Hospital in Springfield, MO. Antibiotics would not typically be prescribed for asthma exacerbation due to viral infections, environmental or chemical allergens, anxiety, or other noninfection-related factors.

If you feel a prescribed antibiotic is inappropriate, Cochran says you should present your case to the physician. "A nurse is always expected to advocate on behalf of their patients, and this situation is no exception," she says.

If you expect that your question will be poorly received, approach it as a learning opportunity for yourself. "Sometimes, simply asking about the thought process of the physician may reveal an angle you hadn't considered," says Cochran.

References

  1. Vanderweil SG, Tsai C, Pelletier, et al. Inappropriate use of antibiotics for acute asthma in United States emergency departments. Acad Emerg Med2008; 15:736-743.
  2. U.S. Department of Health and Human Services; National Institutes of Health; National Heart Lung and Blood institute; National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD; 2007.