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

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.