Impact of national guidelines for antimicrobial stewardship to reduce antibiotic use in upper respiratory tract infection and gastroenteritis

Abstract

Objective: To examine whether the issue and dissemination of national guidelines in the Manual of Antimicrobial Stewardship had an impact on reducing antibiotic use for acute respiratory tract infection (ARTI) and gastroenteritis. Method: An interrupted time-series analysis was performed using a large nationwide database from June 2016 to June 2018. Outpatients with ARTI or gastroenteritis aged ≥6 years were identified. The outcome measures were any antibiotic use and broad-spectrum antibiotic use. The season-adjusted changes in the rate of antibiotic prescriptions for 2 periods before and after the guideline issue date were examined. Results: There were 13,177,735 patients with ARTI and 300,565 patients with gastroenteritis during the study period. Among patients with ARTI, there was a significant downward trend in antibiotic use during the 2-year study period (−0.06% per week; 95% CI, −0.07% to −0.04%). However, there was no significant change in trends of antibiotic use between the pre-issue period and post-issue period (trend difference, −0.01% per week; 95% CI, −0.10% to 0.07%). Similarly, for patients with gastroenteritis, there was no significant change in the trends of antibiotic use between the pre-issue period and post-issue period (trend difference, −0.02% per week; 95% CI, −0.04% to 0.01%). Similar associations were observed in analyses for broad-spectrum antibiotic use. Conclusions: Despite the issue of national guidelines to promote the appropriate use of antibiotics, there were no significant changes in trends of antibiotic use for outpatients with ARTI or gastroenteritis between the pre-issue and post-issue periods.

Multifaceted intervention for improving antimicrobial prescription at discharge in the emergency department

“…However, a nationwide database study revealed that the national guidelines appeared to have no significant impact on antimicrobial use in outpatient care. 10 In the present study, we were unable to assess the length of the APD or changes in prescriptions after the results of cultures done in the emergency department became available because most patients received an antimicrobial prescription for only a few days before receiving follow up from their primary care provider. The relationship between prescribers’ individual level, training year, and subspecialty on interventions was not statistically accessed because of insufficient prescriber variables.…”

Factors influencing receipt of an antibiotic prescription among insured patients in Tanzania: a cross-sectional study

“…This will decrease patient antibiotic expectation. Although some studies show no evidence,37 facility-specific guidelines and algorithms, adapted from national standard treatment guidelines, should be established with respect to properly diagnosing and treating URTIs 38–40…”

Survey of potentially inappropriate prescriptions for common cold symptoms in Japan: A cross-sectional study

“…The third factor is the lack of evidence on physicians’ standard of care for the treatment of common cold. In Japan, despite the publication of national guidelines in 2016 regarding the appropriate use of antimicrobials, there was no significant change in the trend of antimicrobial use among outpatients with acute upper respiratory tract infection before and after the publication [ 39 ]. In this study, the percentage of antimicrobials in prescriptions (83%) was higher than that reported in previous studies (60%) [ 3 ].…”