Antibiotic overuse: managing uncertainty and mitigating against overtreatment

Tarrant, Carolyn; Krockow, Eva M.

doi:10.1136/bmjqs-2021-013615

Cited by 32 publications

(53 citation statements)

References 33 publications

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“…Research from behavioural sciences has repeatedly demonstrated the power of cognitive biases that affect decision-making in a systematic way. Indeed, a recent editorial highlighted specific biases resulting from diagnostic uncertainty in the context of antibiotic prescribing for acute medical patients in secondary care 11. In the context of repeat prescriptions by GPs, slightly different cognitive mechanisms are likely to play a role.…”

Section: The Psychology Of Repeat Prescriptionsmentioning

confidence: 99%

“…Shifting existing social norms and establishing a critical but constructive feedback culture across different healthcare professions are long-term challenges that may be aided through enabling more group-based decision-making approaches11 and creating habits of collegial reviews. Repeat antibiotics can occur through a variety of avenues in general practice and it is important to identify how social norms may affect these different pathways and contribute to acute prescriptions becoming long term.…”

Section: Strategies For Reducing/avoiding Inappropriate Repeat Antibi...mentioning

confidence: 99%

“…Hence, unhelpful strategies of defensive medicine and overprescribing could be replaced with greater efforts to enhance doctor–patient communication and improve patient knowledge. These will need to be implemented alongside ongoing encouragement of ‘safety-netting’ for prescribers11 and continued efforts to increase healthcare staff and public awareness. National and international campaigns, such as Keep Antibiotics Working (UK), Be Antibiotics Aware (USA) and World Antimicrobial Awareness Week (WHO/Global), have sought to promote antimicrobial awareness.…”

Section: Strategies For Reducing/avoiding Inappropriate Repeat Antibi...mentioning

confidence: 99%

See 2 more Smart Citations

Addressing long-term and repeat antibiotic prescriptions in primary care: considerations for a behavioural approach

Krockow

Harvey²,

Ashiru‐Oredope³

2022

BMJ Qual Saf

Self Cite

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Section: The Psychology Of Repeat Prescriptionsmentioning

confidence: 99%

Section: Strategies For Reducing/avoiding Inappropriate Repeat Antibi...mentioning

confidence: 99%

Section: Strategies For Reducing/avoiding Inappropriate Repeat Antibi...mentioning

confidence: 99%

See 1 more Smart Citation

Addressing long-term and repeat antibiotic prescriptions in primary care: considerations for a behavioural approach

Krockow

Harvey²,

Ashiru‐Oredope³

2022

BMJ Qual Saf

Self Cite

View full text Add to dashboard Cite

“…In addition to the concern for missing an infection and the possible consequences (e.g., patient morbidity/mortality and litigation), diagnostic uncertainty drives a substantial amount of unnecessary antibiotic prescribing ( 70 ). There is an inherent contradiction between avoiding the downstream consequences of failed therapy and limiting inappropriate prescribing of antibiotics.…”

Section: Making Smart Prescribing Easiermentioning

confidence: 99%

It’s about the patients: Practical antibiotic stewardship in outpatient settings in the United States

Amin

Dellinger²,

Harnett³

et al. 2022

Front. Med.

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Antibiotic-resistant pathogens cause over 35,000 preventable deaths in the United States every year, and multiple strategies could decrease morbidity and mortality. As antibiotic stewardship requirements are being deployed for the outpatient setting, community providers are facing systematic challenges in implementing stewardship programs. Given that the vast majority of antibiotics are prescribed in the outpatient setting, there are endless opportunities to make a smart and informed choice when prescribing and to move the needle on antibiotic stewardship. Antibiotic stewardship in the community, or “smart prescribing” as we suggest, should factor in antibiotic efficacy, safety, local resistance rates, and overall cost, in addition to patient-specific factors and disease presentation, to arrive at an appropriate therapy. Here, we discuss some of the challenges, such as patient/parent pressure to prescribe, lack of data or resources for implementation, and a disconnect between guidelines and real-world practice, among others. We have assembled an easy-to-use best practice guide for providers in the outpatient setting who lack the time or resources to develop a plan or consult lengthy guidelines. We provide specific suggestions for antibiotic prescribing that align real-world clinical practice with best practices for antibiotic stewardship for two of the most common bacterial infections seen in the outpatient setting: community-acquired pneumonia and skin and soft-tissue infection. In addition, we discuss many ways that community providers, payors, and regulatory bodies can make antibiotic stewardship easier to implement and more streamlined in the outpatient setting.

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“…Studies of antimicrobial use showed over-prescription of antimicrobials related to irrational or unnecessary use where the indication does not correlate with the disease, 3 the clinical diagnosis does not require any medication, or when diagnostic tests have discordant results. 4 …”

Section: Introductionmentioning

confidence: 99%

Antimicrobial Consumption in Latin American Countries: First Steps of a Long Road Ahead

Marín

Giangreco

Dorati

et al. 2022

J Prim Care Community Health

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Background: Irrational antimicrobial consumption (AMC) became one of the main global health problems in recent decades. Objective: In order to understand AMC in Latin-American Region, we performed the present research in 6 countries. Methods: Antimicrobial consumption (J01, A07A, P01AB groups) was registered in Argentina, Chile, Colombia, Costa Rica, Paraguay, and Peru. Source of information, AMC type, DDD (Defined Daily Doses), DID (DDD/1000 inhabitants/day), population were variables explored. Data was analyzed using the Global Antimicrobial Resistance and Use Surveillance System (GLASS) tool. Results: Source of information included data from global, public, and private sectors. Total AMC was highly variable (range 1.91-36.26 DID). Penicillin was the most consumed group in all countries except in Paraguay, while macrolides and lincosamides were ranked second. In terms of type of AMC according to the WHO-AWaRe classification, it was found that for certain groups like “Reserve,” there are similarities among all countries. Conclusion and Relevance: This paper shows the progress that 6 Latin-American countries made toward AMC surveillance. The study provides a standardized approach for building a national surveillance system for AMC data analysis. These steps will contribute to the inclusion of Latin-America among the regions of the world that have periodic, regular, and quality data of AMC.

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Antibiotic overuse: managing uncertainty and mitigating against overtreatment

Cited by 32 publications

References 33 publications

Addressing long-term and repeat antibiotic prescriptions in primary care: considerations for a behavioural approach

Addressing long-term and repeat antibiotic prescriptions in primary care: considerations for a behavioural approach

It’s about the patients: Practical antibiotic stewardship in outpatient settings in the United States

Antimicrobial Consumption in Latin American Countries: First Steps of a Long Road Ahead

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