Antibiotic prescription in asthma exacerbations in the admitting and emergency (A&E) department

Aim: To assess the appropriateness of antibiotic prescription in patients diagnosed with asthma exacerbations in the A&E department. Method: All adult patients presenting at the A&E department over 10 consecutive months (January to October 2010) were included in a prospective study. Comparative statistical analysis was carried out using the t-test. Results: A total of 244 patients were included. Forty-eight patients (19.7%) had been prescribed antibiotics by their general practitioner prior to presentation to A&E. A chest X-ray was done in 201 patients (82.4%). A radiological infiltrate suggestive of pneumonia was reported in 12 patients (6%). A white cell count (WCC) was available in 165 patients (67.6%). Antibiotics were prescribed in 65.9% of admitted patients (n=126). Of these patients 9.5% had a radiological pneumonia, 30.2% had a raised WCC (mean 10.42×10 9 /L), 23% were febrile at presentation and 73% had symptoms of a respiratory tract infection including a cough and/or sputum. Antibiotics were administered to 28 patients (11.5%) at the A&E Department, 3 (10.7%) of whom had a radiological pneumonia. Antibiotics were prescribed to 39.7% of discharged patients (n=118). Of these, 11% had a fever at presentation, 46.6% had symptoms of a respiratory tract infection, and 12.7% had a raised WCC (mean 9.01×10 9 /L). None had evidence of pneumonia. There was no significant correlation in the WCC and antibiotic prescription in admitted and discharged patients (p=0.013). Conclusion: There is a tendency towards unnecessary antibiotic prescription in asthma exacerbations as few patients have evidence of radiological pneumonia or concomitant bacterial infection of the respiratory tract.