Association between Antibiotic Resistance and Community Prescribing: A Critical Review of Bias and Confounding in Published Studies

Abstract

The reported association between antibiotic prescribing and resistance may be subject to bias or confounding. Bias describes any effect at any stage of investigation or inference tending to produce results that depart systematically from the true value. A confounding variable is one that is associated independently with both exposure and outcome. Confounding variables may create an apparent association or mask a real association. Pharmacoepidemiology is the study of the use and the effects of drugs in large numbers of people. We have used standard pharmacoepidemiological methods to investigate sources of bias and confounding in the association between prescribing and resistance. We conclude that the association is statistically valid and that the consistency of evidence supports a cause-effect relationship. Nonetheless, several important sources of bias and confounding must be taken into account in future studies that analyze the impact of prescribing policies on resistance.

A study to evaluate prescribing pattern of antibiotics among patients of urinary tract infection with preexisting renal disorders in a tertiary care hospital

“…21,22 However, current policies are based largely on ecological relationships between prescribing and resistance, and there are only limited data at the level of the individual patient. 23,24 Interventions to improve the quality of antibiotic prescribing could be enhanced if antibiotic policy were based individually for every patient based on safety, tolerability and resistance pattern. 25 This study was designed for gaining knowledge about the type of pathogens responsible for cUTIs and their susceptibility patterns which may help the clinicians to choose the right empirical treatment.…”

Portage rhinopharyngé de <em>Streptococcus pneumoniae</em> chez les enfants

“…En effet la consommation d'antibiotiques est responsable d'une colonisation par des bactéries résistantes, mais également de la survenue d'infections par ces mêmes bactéries. Ceci a largement été rapporté en situation communautaire (Steinke et Davey, 2001).…”

Avaliação Do Uso De Antimicrobianos E Perfil De Usuários De Uma Farmácia Do Sul De Minas Gerais

“…Ainda, calcula-se que 12% de todas as prescrições ambulatoriais sejam de antibióticos, 50% destas prescrições são inapropriadas e 2/3 dos antibióticos disponíveis no mercado são usados sem prescrição médica (McCAIG & HUGHES, 1995;NICOLINI et al, 2008 (HART, 1998;STEINKE & DAVEY, 2001;VOSE et al, 2001;BRONZWAER et al, 2002;CADIEUX et al, 2007). …”