EM · Antimicrobial stewardship in the emergency department

Antimicrobial stewardship in the emergency department — right drug, dose, route and duration, syndromic empirical therapy, de-escalation and resistance

Also known as Antimicrobial stewardship · Antibiotic stewardship · Antimicrobial stewardship programme · Right drug dose duration route · Empirical antibiotic therapy · De-escalation · Syndromic empirical therapy · Antibiotic resistance · MRSA · VRE · ESBL · CPE · Carbapenem-resistant Enterobacterales · Beers criteria · STOPP START · Drug-bug mismatch

Antimicrobial stewardship in the emergency department — the coordinated set of interventions to optimise antimicrobial use, captured in the principle of the right drug, the right dose, the right route and the right duration, with de-escalation when culture and susceptibility data return; the syndromic empirical therapy matrix for the front door — sepsis (ceftriaxone 2 g), community-acquired bacterial meningitis (ceftriaxone plus vancomycin, plus ampicillin if Listeria is a risk), community-acquired pneumonia (ceftriaxone plus azithromycin), cellulitis (flucloxacillin 2 g) and urinary tract infection (trimethoprim or nitrofurantoin); the de-escalation rule of narrow-to-spectrum, stop-when-non-infectious and switch-to-oral when stable; the resistance patterns (MRSA, VRE, ESBL, CPE) and their treatment implications; the Beers 2023 and STOPP/START criteria for the elderly patient; and the regional stewardship frameworks (Australian Therapeutic Guidelines — Antibiotic and ACSQHC, NICE NG15, IDSA/SHEA and the CDC Core Elements). ACEM-primary, globally tagged.