Can 88% of patients with acute lower respiratory infection all be special?

Tilling, Kate

doi:10.3399/bjgp14x676636

Cited by 10 publications

(8 citation statements)

References 13 publications

(22 reference statements)

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“…Increase of antimicrobial resistance Increase of more severe diseases Increase of the length of disease Increase of the risk of complications Increase of the mortality rate Increase of healthcare costs Increase of the risk of adverse effects, some being life-threatening Increase of re-attendance due to infectious diseases Increased medicalization of self-limiting infectious conditions 88% of patients with acute bronchitis are special [Hay and Tilling, 2014]?…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem

Llor

Bjerrum

2014

Therapeutic Advances in Drug Safety

1,305

929

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Antimicrobial resistance is a global public health challenge, which has accelerated by the overuse of antibiotics worldwide. Increased antimicrobial resistance is the cause of severe infections, complications, longer hospital stays and increased mortality. Overprescribing of antibiotics is associated with an increased risk of adverse effects, more frequent re-attendance and increased medicalization of self-limiting conditions. Antibiotic overprescribing is a particular problem in primary care, where viruses cause most infections. About 90% of all antibiotic prescriptions are issued by general practitioners, and respiratory tract infections are the leading reason for prescribing. Multifaceted interventions to reduce overuse of antibiotics have been found to be effective and better than single initiatives. Interventions should encompass the enforcement of the policy of prohibiting the over-thecounter sale of antibiotics, the use of antimicrobial stewardship programmes, the active participation of clinicians in audits, the utilization of valid rapid point-of-care tests, the promotion of delayed antibiotic prescribing strategies, the enhancement of communication skills with patients with the aid of information brochures and the performance of more pragmatic studies in primary care with outcomes that are of clinicians' interest, such as complications and clinical outcomes.

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Section: Introductionmentioning

confidence: 99%

“…[Ashworth et al 2005]. As mentioned recently by Hay and Tilling, how is it possible that 88% of patients with acute bronchitis are special [Hay and Tilling, 2014]?…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem

Llor

Bjerrum

2014

Therapeutic Advances in Drug Safety

1,305

929

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“…A borderline significant interaction term was observed for patients reporting anxiety/depression on the day of the consultation. These (borderline) significant results may be due to multiple testing, and with more conservative p -values, and these results would not be considered significant [ 22 ]. Sensitivity analysis did not alter our conclusions.…”

Section: Discussionmentioning

confidence: 99%

Adverse Effects of Amoxicillin for Acute Lower Respiratory Tract Infection in Primary Care: Secondary and Subgroup Analysis of a Randomised Clinical Trial

et al. 2017

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A European placebo-controlled trial of antibiotic treatment for lower respiratory tract infection (LRTI) conducted in 16 primary care practices networks recruited participants between November 2007 and April 2010, and found adverse events (AEs) occurred more often in patients prescribed amoxicillin compared to placebo. This secondary analysis explores the causal relationship and estimates specific AEs (diarrhoea, nausea, rash) due to amoxicillin treatment for LRTI, and if any subgroup is at increased risk of any or a specific AE. A total of 2061 patients were randomly assigned to amoxicillin (1038) and placebo (1023); 595 (28%) were 60 and older. A significantly higher proportion of any AEs (diarrhoea or nausea or rash) (OR = 1.31, 95% CI 1.05–1.64, number needed to harm (NNH) = 24) and of diarrhoea (OR 1.43 95% CI 1.08–1.90, NNH = 29) was reported in the amoxicillin group during the first week after randomisation. Subgroup analysis showed rash was significantly more often reported in males prescribed amoxicillin (interaction term 3.72 95% CI 1.22–11.36; OR of amoxicillin in males 2.79 (95% CI 1.08–7.22). No other subgroup at higher risk was identified. Although the study was not powered for subgroup analysis, this analysis suggests that most patients are likely to be equally harmed when prescribed antibiotics.

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“…[40][41][42] In the same context, Hay et al showed concerns about why 88% of patients with selflimiting respiratory tract infections are treated with antibiotics. 43 This phenomenon differs greatly by country and region as previous investigations showed that it is associated with culture, socio-economic level, clinical autonomy, country background, and the cultural beliefs of the patients and prescribers. [44][45][46] Hulscher et al expressed that in such countries, people are directed in this path by non-scientific misleading ideas.…”

Section: Optimizing the Antibioticmentioning

confidence: 99%

Chances and prevention of antibiotic resistance in primary health care: literature review

Banamah

Alsamih

Alshehri

et al. 2021

Int J Community Med Public Health

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Many concerns have been expressed in the field of clinical practice regarding antimicrobial resistance since many infections with severe complications and bad prognosis have been described since the end of the last century. In primary healthcare facilities, the risks for developing high rates of antibiotic resistance is high, probably due to the high prevalence of bacterial infections in these places, and due to the overuse of antibiotics without any relevance of evidence of bacterial infections. For instance, people usually administer high doses of broad-spectrum antibiotics for non-severe, self-limiting respiratory tract infections. Moreover, for fighting bacterial infections, patients usually discontinue the treatment course once the symptoms of the disease were relieved. These factors among many others had led to the high prevalence of antibiotic resistance which may lead to serious complications. Many approaches are being made to reduce the resistance that has been reviewed in this review. These include optimizing the dosage and timing of antibiotics administration which can be achieved by more understanding of the pharmacology of the antibiotics. Moreover, training and education programs that target the prescribers and patients have been proven to be efficient in reducing the rates. These efforts are encouraged to last and target more people for more favorable outcomes.

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Can 88% of patients with acute lower respiratory infection all be special?

Cited by 10 publications

References 13 publications

Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem

Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem

Adverse Effects of Amoxicillin for Acute Lower Respiratory Tract Infection in Primary Care: Secondary and Subgroup Analysis of a Randomised Clinical Trial

Chances and prevention of antibiotic resistance in primary health care: literature review

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