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

Abstract

Background 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. Objective This study aims to compare antibiotic prescribing patterns for HS patients in the ED versus ambulatory care setting. Methods 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. Results 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). Conclusion 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.