Patterns of antibiotic use in a busy metropolitan emergency room: analysis of efficacy and cost-appropriateness.

Antibiotics account for 15 percent to 20 percent of all new and refill prescriptions issued in ambulatory community practice. Antibiotic-prescribing practices in our emergency room for common outpatient infections-pharyngitis, bronchitis, sinusitis, otitis media, cellulitis, cutaneous abscesses and pneumonia-were evaluated. Antibiotic selection was compared with recommendations representing current standards for care, and the cost of each was approximated. Antibiotic agents were judged to be overused in patients with pharyngitis, bronchitis and cutaneous abscesses. Patients who had acute sinusitis and otitis media often did not receive antibiotics or received an antibiotic not active against Hemophilus influenzae. A simple audit of antimicrobial drug usage for common outpatient infections proved to be a cost-effective way to identify excessive or inappropriate drug use. This approach could be used for evaluating the use of other drugs, and the results of these evaluations could serve to focus continuing educational programs.