Factors associated with antibiotic prescribing for adults with acute conditions: an umbrella review across primary care and a systematic review focusing on primary dental care

Abstract

Introduction One way to slow the spread of resistant bacteria is by improved stewardship of antibiotics: using them more carefully and reducing the number of prescriptions. With an estimated 7%–10% of antibiotic prescriptions globally originating from dental practices and up to 80% prescribed unnecessarily, dentistry has an important role to play. To support the design of new stewardship interventions through knowledge transfer between contexts, this study aimed to identify factors associated with the decision to prescribe antibiotics to adults presenting with acute conditions across primary care (including dentistry). Methods Two reviews were undertaken: an umbrella review across primary healthcare and a systematic review in dentistry. Two authors independently selected and quality assessed the included studies. Factors were identified using an inductive thematic approach and mapped to the Theoretical Domains Framework (TDF). Comparisons between dental and other settings were explored. Registration number: PROSPERO_CRD42016037174. Results Searches identified 689 publications across primary care and 432 across dental care. Included studies (nine and seven, respectively) were assessed as of variable quality. They covered 46 countries, of which 12 were low and middle-income countries (LMICs). Across the two reviews, 30 factors were identified, with ‘patient/condition characteristics’, ‘patient influence’ and ‘guidelines & information’ the most frequent. Two factors were unique to dental studies: ‘procedure possible’ and ‘treatment skills’. No factor related only to LMICs. Conclusions A comprehensive list of factors associated with antibiotic prescribing to adults with acute conditions in primary care settings around the world has been collated and should assist theory-informed design of new context-specific stewardship interventions.

Does the problem begin at the beginning? Medical students’ knowledge and beliefs regarding antibiotics and resistance: a systematic review

“…With antibiotic resistance being recognised as an important public-health threat worldwide [ 33 ] and physicians being seen as crucially responsible for antibiotic misuse, one strength of this study is having detected that, in many settings, physicians display important shortcomings, dating back to the time of their education, in the treatment of highly common infections. We feel that these results are particularly important, since these shortcomings are easily remediable at this early stage of a medical student’s education: it is simply necessary for the educational and/or health authorities (from a global level all the way down to those responsible for individual educational centres) to ensure that their educational priorities are proportional to the impact which antibiotic misuse has on public health around the world.…”

Antibiotic prescription practices in primary care in low- and middle-income countries: A systematic review and meta-analysis

“…A recently published umbrella review on antibiotic use for adults in primary care (though focused on dental care) identified several factors that appear to affect prescribing behaviors in HICs, such as socio-cultural context, financial incentives, personal beliefs, patients' attitudes, and AMR awareness [80]. Similar considerations likely apply to prescription practices in LMICs, although a deeper understanding of underlying determinants remains challenging.…”

Antibiotic Stewardship for Older Adults in Ambulatory Care Settings: Addressing an Unmet Challenge

“…Patients may see clinicians with different practice patterns regarding antibiotic prescription (either in the same practice or when visiting multiple practices), leading to an expectation for antibiotics. In response to a desire to improve patient satisfaction scores tied to reimbursement or to improve patient critiques on social media sites tied to patient recruitment, clinicians may prescribe antibiotics in an attempt to improve patient satisfaction …”