What is a Rational Approach to Antimicrobial Use in Emergency Situations?


Even though time is not on your side in emergency situations, it’s still possible to be an antimicrobial steward.

“For the emergency patients certainly time usually is not on your side,” explains Kendon Kuo, DVM, MS, DACVECC, assistant clinical professor at the Auburn University College of Veterinary Medicine.

“And so, it's harder to say 'OK let's hold off on antibiotics," because if you wait too long it could make a big difference. And so, a perfect example would be something like sepsis. And for sepsis all the recommendations are, you know, early source control, early antibiotics, and early culturing. But if you can't, you know, if you don't know what you're treating yet a lot of times you just rely on kind of bigger gun antibiotic, or kind of broad-spectrum.

But, I think you can still be antimicrobial steward in the ER setting in the sense that you can take an antibiotic timeout. And so, you know you might start with a bigger gun antibiotic, but then you reevaluate that the next day and then hopefully you'll reevaluate when you get the culture results back, and say 'OK can I deescalate, use a smaller gun, or maybe there was no infection I can just stop the antibiotics?'

I think one thing—you know it's certainly not evidence-based—but we kind of will take a look at our patients and we say do we think this patient is at risk of dying, you know within the next 24 hours? If the answer is yes, then we'll kind of use more broad-spectrum antibiotics. If the answer is no maybe we'll try to you know take the information that we have you know it's this body system these are the common bugs that affect it, these are the common antibiotics that should work, let's start there and then kind of reevaluate in the future.”

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