Seyed Sina Madani - Student Research Committee, Faculty of medicine, Iran University of Medical Sciences, Tehran, Iran
Mahdi Rezaei - Assistant Professor, Emergency Medicine Management Research Center, Iran university of Medical Sciences, Tehran, Iran.
Saeed Abbasi - Assistant Professor, Emergency Medicine Management Research Center, Iran university of Medical Sciences, Tehran, Iran.
Hasan Safehian - Research and Development Center of Firoozgar Hospital, Iran university of Medical Sciences, Tehran, Iran

Background and Objective: Ceftriaxone is being used, widely, these days, and it is less according to the current guidelines. Inappropriate use of antimicrobials can lead to microorganisms resistance to them which could threaten health systems, seriously. The aim of this study was to determine the appropriate usage of ceftriaxone. Considering the results may help looking for a way to prevent its inappropriate use in Emergency Department (ED). Materials and methods: In an observational-analytical cross-sectional study, the patients referred to EDs of Hazrat Rasul Akram and Firoozgar hospitals since September 23, 2015 to March 19, 2016 who have been treated with ceftriaxone, By census method were entered the study.The patients whose data had not been correctly recorded and those not possible to be evaluated for any indication or contraindication to use ceftriaxone were excluded from the study. Totally, 406 patients were enrolled the study. The rational usage of ceftriaxone was determined based on latest evidence based literatures. Quantitative variables were reported as mean and 95% confidence Intervals (CI) while frequency and frequency percentage were used report qualitative variables. Logistic Regression was used to determine independent variables that predict logical use of ceftriaxone in ED. P values less than 0.05 were considered as meaningful. All data were assessed using SPSS 18.Findings: Women constituted 206 (50.7%; 95% CI, 45.8-54.9%) of patients .The mean age of patients was 53.88 (95% CI, 51.63-55.96). Ceftriaxone had been prescribed properly in 156 patients (38.4%; 95% CI, 33.5-42.9%) and its use did not meet logical criteria in the rest of cases consisting of 250 patients (69.6%; 95% CI, 57.1-66.5%). Although prescription of ceftriaxone seemed more logical in more experienced EPs, it did not reach to significance level. (p = 0.068). No statistically meaningful correlation was seen between logical use of ceftriaxone and therapeutic or prophylactic intention to use it (p = 0.617). ceftriaxone had been used more logically in patients complaining of urinary symptoms (p < 0.001). Its usage was less logical when prescribed empirically compared to diagnosis-goaled prescription (24.34% vs. 80.4%; p < 0.001). Also ceftriaxone had been used more logically according to higher level of triage in patients, from level V to level I (p < 0.001). Regression analysis performed to determine independent effect of factors on logical use of ceftriaxone in ED and it showed that not-empiric prescription (goal directed usage), triage level I and II, and Urinary symptoms as chief complaint could predict meaningfully the logical use of ceftriaxone in ED.Conclusion: Our study revealed a range of appropriate use of ceftriaxone not acceptable for a teaching medical center; more education seems to be necessary in this field.

Antibiotic, Ceftriaxone, Guideline, Emergency