Picking the low-hanging fruit: Why not choose oral antibiotics for skin and soft-tissue infections in the emergency department

Emerg Med Australas. 2019 Dec;31(6):1119-1122. doi: 10.1111/1742-6723.13383. Epub 2019 Aug 27.

Abstract

Skin and soft-tissue infections are a common presentation to EDs in Australasia. In the absence of sepsis or decreased oral absorption, substantial supportive data exists that shows oral antibiotics are non-inferior to intravenous antibiotics for uncomplicated skin and soft-tissue infections. However, despite a fair evidence base, clinicians are not consistently putting this into practice. This perspective reviews the relevant literature, discusses barriers to the implementation of this more parsimonious approach and also proposes several potential solutions. It is important that ED clinicians are encouraged to use oral antibiotics for uncomplicated infections, as this would lead to similar clinical outcomes but with fewer resources for staff and patient, as well as increased patient satisfaction.

Keywords: antimicrobial stewardship; cellulitis; choosing wisely; oral antibiotics; skin and soft tissue infection.

MeSH terms

  • Administration, Intravenous
  • Administration, Oral
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Australasia
  • Decision Making
  • Emergency Service, Hospital*
  • Humans
  • Soft Tissue Infections / drug therapy*
  • Soft Tissue Infections / microbiology

Substances

  • Anti-Bacterial Agents