Antibiotic Prescription Pattern for Viral Respiratory Illness in Emergency Room and Ambulatory Care Settings

Ahmed, M. S.; Muyot, Maria M.; Begum, Shamim Ara; Smith, Patti; Little, Charletta; Windemuller, Fernando J.

doi:10.1177/0009922809357786

Cited by 40 publications

(35 citation statements)

References 16 publications

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“…Just over half of the included studies were from the United States (n ϭ 15) (11,20,21,24,26,28,30,31,33,(38)(39)(40)(45)(46)(47), with the remainder from Canada (n ϭ 3) (34,37,43), The Netherlands (n ϭ 2) (29,35), Germany (n ϭ 2) (23, 42), Italy (n ϭ 1) (27), the United Kingdom (n ϭ 1) (25), Belgium (n ϭ 1) (22), and a network of 13 European countries (n ϭ 3) (36,41,44). Eight of the U.S. studies used the NAMCS (National Ambulatory Medical Care Survey) or NHAMCS (National Hospital Ambulatory Medical Care Survey) data sets for their analyses (11,28,31,33,(38)(39)(40)46).…”

Section: Resultsmentioning

confidence: 99%

“…Eight of the U.S. studies used the NAMCS (National Ambulatory Medical Care Survey) or NHAMCS (National Hospital Ambulatory Medical Care Survey) data sets for their analyses (11,28,31,33,(38)(39)(40)46). Analyses included pediatric populations only in 5 studies (20,27,28,38,43) and adult populations only in 10 studies (11, 23-25, 39-42, 46, 47), while the rest either included all ages or did not specifically describe the patient population.…”

Section: Resultsmentioning

confidence: 99%

“…Patient age and sex were the most commonly studied factors. Of the 10 studies that explored sex (11,20,25,28,30,33,37,38,40,43), just one found a statistically significant association between male sex and higher odds of antibiotic prescription (43). Nineteen studies explored age as a factor (11, 20-22, 25, 27-30, 33, 35, 37-43, 46); of all of the comparisons made, 18 aORs were nonsignificant, 10 suggested that older people had higher odds/risk of a prescription than younger people, and 3 suggested that younger people had higher odds.…”

Section: Resultsmentioning

confidence: 99%

“…2c), while one found no relationship (36) and one had a 95% confidence interval very close to 1 (23). Two of the studies that addressed fever were of children (20,27), while the rest were of adults (22,23,47) (Fig. 2b).…”

Section: Diagnosis Of Bronchitismentioning

confidence: 92%

“…Six studies assessed the association of a diagnosis of bronchitis with an antibiotic prescription (20,21,30,33,37,38); all found statistically significant positive associations (aORs ranging from 2.9 to 15.9), although only two reported the number of unique physicians in the sample and accounted for clustering (Fig. 2a).…”

Section: Diagnosis Of Bronchitismentioning

confidence: 99%

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Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections

McKay

Mah

Law

et al. 2016

Antimicrob Agents Chemother

166

153

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Antibiotic use is a modifiable driver of antibiotic resistance. In many circumstances, antibiotic use is overly broad or unnecessary. We systematically assessed factors associated with antibiotic prescribing for respiratory tract infections (RTI). Studies were included if they used actual (not self-reported or intended) prescribing data, assessed factors associated with antibiotic prescribing for RTIs, and performed multivariable analysis of associations. We searched Medline, Embase, and International Pharmaceutical Abstracts using keyword and MeSH (medical subject headings) search terms. Two authors reviewed each abstract and independently appraised all included texts. Data on factors affecting antibiotic prescribing were extracted. Our searches retrieved a total of 2,848 abstracts, with 97 included in full-text review and 28 meeting full inclusion criteria. Compared to other factors, diagnosis of acute bronchitis was associated with increased antibiotic prescribing (range of adjusted odds ratios [aOR], 1.56 to 15.9). Features on physical exam, such as fever, purulent sputum, abnormal respiratory exam, and tonsillar exudate, were also associated with higher odds of antibiotic prescribing. Patient desire for an antibiotic was not associated or was modestly associated with prescription (range of aORs, 0.61 to 9.87), in contrast to physician perception of patient desire for antibiotics, which showed a stronger association (range of aORs, 2.11 to 23.3). Physician's perception of patient desire for antibiotics was strongly associated with antibiotic prescribing. Antimicrobial stewardship programs should continue to expand in the outpatient setting and should emphasize clear and direct communication between patients and physicians, as well as signs and symptoms that do and do not predict bacterial etiology of upper respiratory tract infections.T he rapid and ongoing spread of antimicrobial-resistant organisms threatens our ability to successfully treat a growing number of infectious diseases (1, 2). It is well established that antibiotic use is a significant, and modifiable, driver of antibiotic resistance (3-5), and that antibiotics are often misused (6). In settings where a prescription is required to access antibiotics, the prescriber-patient encounter is a logical target for improving appropriate use.Despite the importance of the topic, there is no existing systematic review to identify drivers of antibiotic prescribing from real prescription data. A narrative review of factors influencing antibiotic prescribing highlighted the multiple sources of influence affecting a potential prescribing encounter, including factors related to the prescribing physician (e.g., fear of failure, diagnostic uncertainty, or inadequate training), the patient (e.g., a high-risk or vulnerable patient history), and the environment (e.g., regulation of pharmaceutical prescribing and dispensing and lack of resources for etiological diagnosis) (7). Another study systematically reviewed reasons for inappropriate antibiotic prescriptions, f...

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