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Avoidable Antibiotic Exposure for Skin and Soft Tissue Infections

Summary and Comment |
December 18, 2013

Avoidable Antibiotic Exposure for Skin and Soft Tissue Infections

  1. Neil M. Ampel, MD

In a retrospective analysis, therapy for at least 10 days was the most common reason for avoidable antibiotic use.

  1. Neil M. Ampel, MD

Antibiotics for cellulitis and cutaneous abscesses are among the most common outpatient prescriptions. Avoiding unnecessary antibiotic use is a critical component in efforts to prevent increasing antimicrobial resistance and to improve patient safety. However, little is known about current outpatient prescribing practices for skin and soft tissue infections.

In previous work, researchers in Colorado demonstrated that overly broad-spectrum antibiotics with prolonged courses were being prescribed for the in-hospital management of patients with cellulitis and cutaneous abscess. Now, they have extended their investigation to examine practices in a large ambulatory care system.

The study involved a retrospective cohort of 364 patients with a primary diagnosis of skin and soft tissue infection who presented to outpatient areas of the Denver Health system between March 2010 and February 2011. The cases were divided into three groups: cutaneous abscess (168), cellulitis (155), and wound infection (41).

Antibiotic regimens with activity against methicillin-resistant Staphylococcus aureus were prescribed for 93% of patients with abscesses, 61% of those with cellulitis, and 58% of those with wound infections. Among the 292 patients with complete prescribing information, 135 (46%) had avoidable antibiotic exposure. Such exposure involved antibiotics with overly broad activity against gram-negative bacilli in 11 patients (4%), combination therapy in 35 (12%), and treatment for ≥10 days in 122 (42%).

Comment

In this study, the most common reason identified for avoidable antibiotics was prescribing for ≥10 days. However, 61% of patients with uncomplicated cellulitis received antibiotics with activity against methicillin-resistant S. aureus — a practice that many would consider inappropriate.

  • Disclosures for Neil M. Ampel, MD at time of publication Editorial boards Medical Mycology

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