Ezra Margolin, MD, highlights trends in antibiotic prescribing for kidney stones

In the following video, Ezra J. Margolin, MD, discusses the motivation behind a recent study examining antibiotic prescribing patterns for patients presenting to the emergency department (ED) with kidney stones.¹ Margolin is an assistant professor of urology at Columbia University Irving Medical Center in New York, New York.

Margolin emphasized that the work was rooted in concerns around antibiotic stewardship, noting that many patients treated for stone episodes in the ED are discharged with antibiotics that may not be clinically necessary. Because EDs serve as a primary point of entry into the health care system for these patients and given the recurrent nature of nephrolithiasis, unwarranted antibiotic exposure can accumulate over time, increasing the risk of antimicrobial resistance even with short treatment courses.

To better understand national practice patterns, the investigators analyzed data from the National Hospital Ambulatory Medical Care Survey spanning 2015 to 2022. According to Margolin, this data set includes information from approximately 300 EDs across the United States and uses weighted sampling to generate national estimates. The study focused on patients who were treated and subsequently discharged from the ED with a diagnosis of ureteral stones, evaluating how frequently antibiotics were administered during the visit and prescribed at discharge.

Overall, the findings showed that 23% of patients received antibiotics, including 13% who received antibiotics in the ED and an additional 17% via discharge prescriptions (nonmutually exclusive designations). The investigators also noted higher prescribing rates for women (OR, 2.24), older adults aged 65 to 74 (OR, 5.24), and those with concurrent infection (OR, 11.15) (all P < .01).

Although antibiotic use declined in the early years of the study period, this improvement plateaued around 2020. By 2022, prescribing rates had risen again, surpassing those seen at the start of the study period, underscoring ongoing challenges in optimizing antibiotic stewardship in this clinical setting.

According to the authors, “the COVID-19 pandemic may have set back national efforts in antibiotic stewardship.”

REFERENCE

1. Berman RB, Drebin HM, Johnson JP, Shah O, Margolin EJ. Trends in antibiotic use for kidney stone patients discharged from United States emergency departments. J Endourol. 2026:40(4):498-503. doi:10.1177/08927790261420555