I previously wrote over at BoringEM.org about not giving a dose of IV antibiotics for various entities when there is a PO equivalent. Here is one more reason to not give a dose of an intravenous antibiotic before discharge – they have an increased risk of antibiotic associated diarrhea and C difficile.
The numbers are small but I believe the message is real: 26% of patients that received A SINGLE DOSE of IV antibiotics had a 26% chance of developing antibiotic associated diarrhea, vs 12% who received oral antibiotics only. Admittedly, there were only two patients that developed C diff out of 247 patients between the PO and IV arms. Both of these patients had been given a dose of a broad spectrum antibiotic prior to discharge from the ED. The OR for antibiotic associated diarrhea was 2.7 and, curiously, 3 if you were hispanic.
To back this up, there is this study where they cut their Cdiff rate in half by using narrow spectrum antibiotics (cough, not VancoSYnTriaxone cough cough) on an “elderly care unit” and importantly, their mortality and length of stay did not change.
So please, please, please… stop giving a dose of Zosyn for cat bite cellulitis before discharge. Perhaps this even calls into question the common practice of giving a dose of ceftriaxone before discharge for pyelonephritis or community acquired pneumonia.