Appropriate Antibiotic Prescribing—The Safer and Less Expensive Choice

Smith, Michael J.; Wattles, Bethany A.

doi:10.1001/jamanetworkopen.2022.14160

Cited by 3 publications

(1 citation statement)

References 5 publications

(8 reference statements)

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“…Fifth, the use of additional antibiotics along with the recommended empirical antibiotics for uncomplicated UTIs was noted in the current study. Inappropriate prescribing of extra antibiotics will increase healthcare costs and promote AMR [49,50]. The unnecessary use of a single dose of intravenous antibiotics, especially a third-generation cephalosporin (ceftriaxone), is a worrying trend since these should be reserved for complicated UTIs [51].…”

Section: Discussionmentioning

confidence: 99%

Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019–2021

Owusu

Thekkur

Ashubwe-Jalemba³

et al. 2022

IJERPH

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Increasing trends in antimicrobial resistance among uropathogens call for rational use of empirical antibiotics for managing uncomplicated urinary tract infections (UTIs). In Ghana, standard treatment guidelines (STGs) for UTI recommend oral ciprofloxacin or cefuroxime for 5–7 days in females and 10–14 days in males. We conducted a cross-sectional audit using electronic medical records (EMR) to assess compliance to the STGs among adults (≥18 years) with uncomplicated UTIs diagnosed in a primary health facility between October 2019 and October 2021. Among 3717 patients, 71% were females and all had complete prescription details in the EMR. Of all the patients, 83% were prescribed empirical antibiotics, of whom 88% received oral ciprofloxacin or cefuroxime. Only 68% were prescribed antibiotics for the correct duration, which was significantly lower among males (10%) compared to females (90%). Among patients who received antibiotics, 60% were prescribed in line with the STGs. The results call for feedback to physicians about poor compliance to STGs with duration of antibiotic prescribed. Recommendations on 10–14 days duration of antibiotics for males needs to be reassessed and necessary amendments to STGs can be made. Leveraging the well-established EMR system, a real-time audit-feedback mechanism can be instituted to improve compliance with STGs.

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Section: Discussionmentioning

confidence: 99%

Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019–2021

Owusu

Thekkur

Ashubwe-Jalemba³

et al. 2022

IJERPH

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Antibiotic pollution and associated antimicrobial resistance in the environment

Barathe,

Kaur,

Reddy

et al. 2024

Journal of Hazardous Materials Letters

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Comparative Safety and Attributable Healthcare Expenditures Following Inappropriate Versus Appropriate Outpatient Antibiotic Prescriptions Among Adults With Upper Respiratory Infections

Butler

Brown

Newland

et al. 2022

Clinical Infectious Diseases

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Background Little is known about the clinical and financial consequences of inappropriate antibiotics. We aimed to estimate the comparative risk of adverse drug events and attributable health care expenditures associated with inappropriate versus appropriate antibiotic prescriptions for common respiratory infections. Methods We established a cohort of adults 18–64 years with an outpatient diagnosis of a bacterial (pharyngitis, sinusitis) or viral respiratory infection (influenza, viral URI, non-suppurative otitis media (OM), bronchitis) from April 1, 2016 to September 30, 2018 using Merative™ MarketScan® Commercial Database. The exposure was an inappropriate versus appropriate oral antibiotic (i.e., non-guideline-recommended versus guideline-recommended antibiotic for bacterial infections; any versus no antibiotic for viral infections). Propensity score-weighted Cox proportional hazards models were used to estimate the association between inappropriate antibiotics and adverse drug events. Two-part models were used to calculate 30-day all-cause attributable health care expenditures by infection type. Results Among 3,294,598 eligible adults, 43%–56% received inappropriate antibiotics for bacterial and 7%–66% for viral infections. Inappropriate antibiotics were associated with increased risk of several adverse drug events, including Clostridioides difficile infection and nausea/vomiting/abdominal pain (HR, 2.90; 95% CI, 1.31–6.41 and HR, 1.10; 95% CI, 1.03–1.18, respectively, for pharyngitis). Thirty-day attributable health care expenditures were higher among adults who received inappropriate antibiotics for bacterial infections ($18–$67) and variable (-$53–$49) for viral infections. Conclusions Inappropriate antibiotic prescriptions for respiratory infections were associated with increased risks of patient harm and higher health care expenditures, justifying a further call-to-action to implement outpatient antibiotic stewardship programs.

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Appropriate Antibiotic Prescribing—The Safer and Less Expensive Choice

Cited by 3 publications

References 5 publications

Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019–2021

Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019–2021

Antibiotic pollution and associated antimicrobial resistance in the environment

Comparative Safety and Attributable Healthcare Expenditures Following Inappropriate Versus Appropriate Outpatient Antibiotic Prescriptions Among Adults With Upper Respiratory Infections

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