Guideline Adherence in Antibiotic Prescribing to Patients with Respiratory Diseases in Primary Care: Prevalence and Practice Variation

Abstract

Respiratory tract infections (RTIs) account for a large part of antibiotic prescriptions in primary care. However, guidelines advise restrictive antibiotic prescribing for RTIs. Only in certain circumstances, depending on, e.g., comorbidity, are antibiotics indicated. Most studies on guideline adherence do not account for this. We aimed to assess guideline adherence for antibiotic prescribing for RTIs as well as its variation between general practices (GPs), accounting for patient characteristics. We used data from electronic health records of GPs in the Netherlands. We selected patients who consulted their GP for acute cough, rhinitis, rhinosinusitis or sore throat in 2014. For each disease episode we assessed whether, according to the GP guideline, there was an indication for antibiotics, using the patient’s sociodemographic characteristics, comorbidity and co-medication. We assessed antibiotic prescribing for episodes with no or an unsure indication according to the guidelines. We analysed 248,896 episodes. Diagnoses with high rates of antibiotic prescribing when there was no indication include acute tonsillitis (57%), strep throat (56%), acute bronchitis (51%) and acute sinusitis (48%). Prescribing rates vary greatly between diagnoses and practices. Reduction of inappropriate antibiotic prescribing remains a key target to tackle antimicrobial resistance. Insight into reasons for guideline non-adherence may guide successful implementation of the variety of interventions already available for GPs and patients.

Determinants of inappropriate antibiotic prescription in primary care in developed countries with general practitioners as gatekeepers: a systematic review and construction of a framework

“…GPs prescribe antibiotics for a variety of infectious diseases, ranging from respiratory tract infections (RTI) to cellulitis 5–10. However between 44% and 98% of the antibiotic prescriptions for RTIs are classified as inappropriate 11–14. The proportion of inappropriate antibiotic prescriptions for urinary tract infections is estimated at between 3% and 36.5% 15 16.…”

Outpatient prescribing pattern for acute bronchitis in primary healthcare settings in China

“…Our results indicated that, in 2017, Chinese primary healthcare clinicians prescribed antibiotics for nearly half of outpatients with acute bronchitis, which was a lower rate than those in the studies conducted in Italy (73.5%) 13 , US (74%) 14 , Belgium (69.0%) 15 , Spain (58.6%) 16 , Japan (52.8%) 17 , and Netherlands (51.0%) 18 , and was also lower than previous studies in China (77.5–95.2%) 9 , 11 . However, our rate was slightly higher than the rate showed in the study conducted in Swiss (41.5%) 19 .…”

Identification of provider and patient characteristics associated with antibiotic prescription in the treatment of acute sinusitis

“…There are opportunities for outpatient antimicrobial stewardship interventions for acute sinusitis treatment. Identifying reasons for provider nonadherence to antibiotic prescribing guidelines is crucial to design and implement antimicrobial stewardship interventions (Hek et al, 2020). Educational interventions for providers, with a focus on antibiotic stewardship for ARTIs, can play significant role in reducing unnecessary antibiotic prescription for acute sinusitis treatment.…”