Defining the appropriateness and inappropriateness of antibiotic prescribing in primary care

Dp, Smith; Dolk, F Christiaan K; Pouwels, Koen B; Christie, Morag; Robotham, Julie V.; Smieszek, Timo

doi:10.1093/jac/dkx503

Cited by 78 publications

(78 citation statements)

References 41 publications

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“…co-morbidity). 31 Our study does not account for this. It would be prudent, therefore, for future work to assess the appropriateness of antibiotic prescribing for GPs located in deprived areas.…”

Section: Strengths and Limitationsmentioning

confidence: 84%

An examination of trends in antibiotic prescribing in primary care and the association with area-level deprivation in England

Thomson

Berry

Robinson

et al. 2020

Preprint

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Background Internationally, there are growing concerns about antimicrobial resistance. This has resulted in increased scrutiny of antibiotic prescribing trends – particularly in primary care where the majority of prescribing occurs. In England, antibiotic prescribing targets are set nationally but little is known about the local context of antibiotic prescribing. This study aimed to examine trends in antibiotic prescribing (including broad-spectrum), and the association with area-level deprivation and region in England. Methods Antibiotic prescribing data by GP surgery in England were obtained from NHS Business Service Authority for the years 2014-2018. These data were matched with the Index of Multiple Deprivation (IMD 2015) at the Lower Layer Super Output level (LSOA). Linear regression methods were employed to explore the relationship between antibiotic use and area-level deprivation as well as region, after controlling for a range of other confounding variables, including health need, rurality, and ethnicity. Results Over time, the amount of antibiotic prescribing significantly reduced from 1.11 items per STAR-PU to 0.96 items per STAR-PU – a reduction of 13.6%. The adjusted models found that, at LSOA level, the most deprived areas of England had the highest levels of antibiotic prescribing (0.03 items per STAR-PU higher). However, broad spectrum antibiotic prescribing exceeding 10% of all antibiotic prescribing within a GP practice was higher in more affluent areas. There were also significant regional differences – with the North East and the East of England having the highest levels of antibiotic prescribing (by 0.16 items per STAR-PU).Conclusion Although antibiotic prescribing has reduced over time, there remains significant variation in by area-level deprivation and region in England – with higher antibiotic prescribing in more deprived areas. Future prescribing targets should account for local factors to ensure the most deprived communities are not inappropriately penalised.

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Section: Strengths and Limitationsmentioning

confidence: 84%

An examination of trends in antibiotic prescribing in primary care and the association with area-level deprivation in England

Thomson

Berry

Robinson

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…23 The ideal percentage rate for antibiotic prescription for acute bronchitis has currently been established at 13%. 24 Our study clearly shows that a single intervention fails to achieve this goal, since this percentage was not met either after the intervention or In conclusion, antibiotic prescription for LRTIs remained similar 6 years later among doctors exposed to the intervention, whereas control GPs prescribed significantly more antibiotics. However, the impact of the intervention was more intense 1-3 months after the intervention than 6 years later, since GPs assigned to the intervention group interpreted the CRP results differently 6 years later as they were less confident to withhold antibiotic therapy for patients with low CRP concentrations compared with what they did just after the intervention.…”

Section: Discussionmentioning

confidence: 59%

“…The ideal percentage rate for antibiotic prescription for acute bronchitis has currently been established at 13% . Our study clearly shows that a single intervention fails to achieve this goal, since this percentage was not met either after the intervention or 6 years later without any reminder.…”

Section: Discussionmentioning

confidence: 72%

Reducing antibiotic prescribing for lower respiratory tract infections 6 years after a multifaceted intervention

Molero

Moragas²,

López-Valcarcel

et al. 2019

Int J Clin Pract

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Summary Aims Few studies have evaluated the long‐term impact of interventions on antibiotic prescription for lower respiratory tract infections (LRTI). This study was aimed at evaluating the use of antibiotics prescribed for LRTIs by general practitioners (GP) who underwent a multifaceted intervention carried out 6 years earlier. Methods General practitioners who had completed two registrations in 2008 and 2009 were again invited to participate in a third audit‐based study in 2015. A multifaceted intervention was held 1‐3 months before the second registration. A new group of GPs with no previous training on the rational use of antibiotics were also invited to participate and acted as controls. Multilevel logistic regression was performed considering the prescription of antibiotics as the dependent variable. Results A total of 121 GPs of the 210 who underwent the intervention (57.6%) and 117 control GPs registered 4333 episodes of LRTIs. On adjustment for covariables, compared with the antibiotic prescription for LRTIs observed just after the intervention, antibiotic prescription slightly increased 6 years later among GPs who had undergone the intervention (OR 1.17, 95% CI 0.95‐1.43), while control GPs prescribed significantly more antibiotics (OR 2.31, 95% CI 1.62‐3.29). However, withholding antibiotic prescribing with C‐reactive protein (CRP) values <10 mg/L was more frequently observed just after the intervention compared 6 years later (12.7% vs 32.2%; P < 0.01). Conclusions Antibiotic prescribing for LRTIs remains low 6 years after an intervention, although GPs are less confident to withhold antibiotic therapy in patients with low CRP levels.

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“…A strength of our study is that we derived our tier classification using a more rigorous modified Delphi method. Two previous studies have derived ideal antibiotic prescribing rates for UK (21) and European (22) primary care settings. The appropriateness rates in those studies are shown and compared with the current consensus-defined Canadian appropriateness rates in Table 3.…”

Section: Discussionmentioning

confidence: 99%

Defining appropriate antibiotic prescribing in primary care: A modified Delphi panel approach

Langford

et al. 2020

Official Journal of the Association of Medical Microbiology and

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BACKGROUND: Antimicrobial overuse contributes to antimicrobial resistance. In the ambulatory setting, where more than 90% of antibiotics are dispensed, there are no Canadian benchmarks for appropriate use. This study aims to define the expected appropriate outpatient antibiotic prescribing rates for three age groups (<2, 2-18, >18 years) using a modified Delphi method. METHODS: We developed an online questionnaire to solicit from a multidisciplinary panel (community-academic family physicians, adult-paediatric infectious disease physicians, and antimicrobial stewardship pharmacists) what percentage of 23 common clinical conditions would appropriately be treated with systemic antibiotics followed with in-person meetings to achieve 100% consensus. RESULTS: The panelists reached consensus for one condition online and 22 conditions face-to-face, which took an average of 2.6 rounds of discussion per condition (range, min-max 1-5). The consensus for appropriate systemic antibiotic prescribing rates were, for pneumonia, pyelonephritis, non-purulent skin and soft tissue infections (SSTI), other bacterial infections, and reproductive tract infections,

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Defining the appropriateness and inappropriateness of antibiotic prescribing in primary care

Cited by 78 publications

References 41 publications

An examination of trends in antibiotic prescribing in primary care and the association with area-level deprivation in England

An examination of trends in antibiotic prescribing in primary care and the association with area-level deprivation in England

Reducing antibiotic prescribing for lower respiratory tract infections 6 years after a multifaceted intervention

Defining appropriate antibiotic prescribing in primary care: A modified Delphi panel approach

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