Comparing antibiotic prescribing patterns for hidradenitis suppurativa between the emergency department and ambulatory care setting

TL;DR

This study compares how often and which antibiotics are prescribed for hidradenitis suppurativa in emergency departments versus outpatient clinics.

Contribution

The study reveals significant differences in antibiotic prescribing rates and types between emergency and ambulatory settings for hidradenitis suppurativa.

Findings

ED visits had a 74.7% antibiotic prescription rate, significantly higher than the 49.0% rate in ambulatory care.

Trimethoprim/sulfamethoxazole was most commonly prescribed in EDs, while tetracyclines dominated in ambulatory settings.

Multivariate analysis showed ED visits had 3.88 times higher odds of antibiotic prescriptions compared to ambulatory visits.

Abstract

Oral antibiotics are a mainstay of treatment for hidradenitis suppurativa (HS), primarily due to their anti-inflammatory and anti-microbial properties. There is a paucity of literature comparing how antibiotic prescribing patterns for HS patients differ between the emergency department (ED) and ambulatory care settings.

This study aims to compare antibiotic prescribing patterns for HS patients in the ED versus ambulatory care setting.

We utilized the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to identify visits for HS patients in 2005-2016, 2018, and 2019. We performed multivariate logistic regression analysis to compare the likelihood of prescribing antibiotic therapy versus no antibiotic therapy between the ED and ambulatory care settings.

We identified a weighted total of 3,041,193 HS patient visits. Approximately 49.0% of ambulatory visits resulted in antibiotic prescriptions. The most frequently prescribed antibiotics in the ambulatory setting were tetracyclines (41.2%), clindamycin (35.9%), and trimethoprim/sulfamethoxazole (21.6%). Approximately 74.7% of ED visits resulted in antibiotic prescriptions. The most frequently prescribed antibiotics in the ED setting were trimethoprim/sulfamethoxazole (44.5%), beta-lactams (33.2%), and clindamycin (27.7%). Multivariate logistic regression demonstrated significantly higher odds of receiving antibiotics in ED visits compared to ambulatory care visits. (OR 3.88; 95% Cl, 1.28-11.77; p = 0.02).

Antibiotic class selection varied significantly between the ED and ambulatory settings. Additionally, ED visits were more likely to result in antibiotic prescriptions than ambulatory visits for HS patients.

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