Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care

Coxeter, Peter; Mar, Chris Del; McGregor, Leanne; Beller, Elaine; Hoffmann, Tammy

doi:10.1002/14651858.cd010907.pub2

Cited by 156 publications

(153 citation statements)

References 51 publications

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“…8 This contrasts with practice in the Netherlands, where 22.5% of RTI episodes in 2010 were treated with antibiotics. 9 A considerable amount of research has been done [10][11][12] to develop interventions that might help general practitioners to reduce the rate of antibiotic prescribing for RTIs. This has been translated into policy guidance 3 and public campaigns 13 to control unnecessary antibiotic use.…”

Section: What This Study Addsmentioning

confidence: 99%

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records

Gulliford

Moore

Little

et al. 2016

BMJ

120

114

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Objective To determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome is higher in general practices that prescribe fewer antibiotics for self limiting respiratory tract infections (RTIs).Design Cohort study.Setting 610 UK general practices from the UK Clinical Practice Research Datalink.Participants Registered patients with 45.5 million person years of follow-up from 2005 to 2014.Exposures Standardised proportion of RTI consultations with antibiotics prescribed for each general practice, and rate of antibiotic prescriptions for RTIs per 1000 registered patients.Main outcome measures Incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome, adjusting for age group, sex, region, deprivation fifth, RTI consultation rate, and general practice.Results From 2005 to 2014 the proportion of RTI consultations with antibiotics prescribed decreased from 53.9% to 50.5% in men and from 54.5% to 51.5% in women. From 2005 to 2014, new episodes of meningitis, mastoiditis, and peritonsillar abscess decreased annually by 5.3%, 4.6%, and 1.0%, respectively, whereas new episodes of pneumonia increased by 0.4%. Age and sex standardised incidences for pneumonia and peritonsillar abscess were higher for practices in the lowest fourth of antibiotic prescribing compared with the highest fourth. The adjusted relative risk increases for a 10% reduction in antibiotic prescribing were 12.8% (95% confidence interval 7.8% to 17.5%, P<0.001) for pneumonia and 9.9% (5.6% to 14.0%, P<0.001) for peritonsillar abscess. If a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then it might observe 1.1 (95% confidence interval 0.6 to 1.5) more cases of pneumonia each year and 0.9 (0.5 to 1.3) more cases of peritonsillar abscess each decade. Mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome were similar in frequency at low prescribing and high prescribing practices.Conclusions General practices that adopt a policy to reduce antibiotic prescribing for RTIs might expect a slight increase in the incidence of treatable pneumonia and peritonsillar abscess. No increase is likely in mastoiditis, empyema, bacterial meningitis, intracranial abscess, or Lemierre’s syndrome. Even a substantial reduction in antibiotic prescribing was predicted to be associated with only a small increase in numbers of cases observed overall, but caution might be required in subgroups at higher risk of pneumonia.

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Section: What This Study Addsmentioning

confidence: 99%

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records

Gulliford

Moore

Little

et al. 2016

BMJ

120

114

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“…These findings suggests opportunities for improving acute respiratory infection visits by adopting shared decision making, in which the options (using or not using antibiotics) and the benefits and harms of each are explained; parents' concerns, beliefs, expectations, and preferences are explored; and a decision is reached collaboratively. 35 Shared decision making is an effective strategy for reducing antibiotic prescribing for acute respiratory infections in primary care, 36 but widespread implementation is limited. This study found most parents wanted to be involved in these decisions.…”

mentioning

confidence: 99%

Parents’ Expectations and Experiences of Antibiotics for Acute Respiratory Infections in Primary Care

2017

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PURPOSE Primary care visits for children with acute respiratory infections frequently result in antibiotic prescriptions, although antibiotics have limited benefits for common acute respiratory infections and can cause harms, including antibiotic resistance. Parental demands are often blamed for antibiotic prescription. We aimed to explore parents' beliefs about antibiotic necessity, quantify their expectations of antibiotic benefit, and report experiences of other management options and exposure to and preferences for shared decision making.

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“…Esta sazonalidade pode estar superestimada pelo fato de que, nessas épocas do ano, as sintomatologias comuns das morbidades alérgicas e virais podem acarretar prescrição precipitada de antibacterianos (22).…”

Section: Resultsunclassified

Prescrições De Antibacterianos Em Uma Drogaria Do Município De Tanabi, São Paulo, Brasil

Lima

Silva

Pereira

et al. 2017

Infarma

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Antimicrobial drugs are substances able to prevent the proliferation or death of infectious agents, combating and preventing the dissemination of an infection. The abusive or inappropriate use of these drugs leads to the development of strains of multi-resistant microrganisms. The aim of this study was to describe the antimicrobial drug consumption in a drugstore at Tanabi, São Paulo, Brazil. This is a retrospective, descriptive, exploratory study with a quantitative approach. There were analyzed 128 prescriptions containing antimicrobial drugs dispensed in 2016. 64% of the prescriptions were destined to the female gender. The average age was 46 ± 25 years. The most prescribed antimicrobials were cephalexin (23%), amoxicillin associated with clavulanate (22%), ciprofloxacin (17%) and azithromycin (15%). Consequently, the most commonly used pharmacological groups were beta-lactams (55%), fluoroquinolones (30%) and macrolides (15%), respectively. The most frequent prescribers were general phisicians (42%), dentist (12%), cardiologist (9%) and urologist (7%). Most of the prescriptions came from the private health system (54%). The prescribers used the trade name in 55% of the prescribed antimicrobials, of which 33% were destined to the public health system. This research contributes to evaluation of the use of antimicrobial drugs in population. The effective action of the Pharmacist in the control the use of antibacterials in accordance with current legislation is important to provide the population with adequate guidelines on the rational use of these agents.

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Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care

Cited by 156 publications

References 51 publications

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records

Parents’ Expectations and Experiences of Antibiotics for Acute Respiratory Infections in Primary Care

Prescrições De Antibacterianos Em Uma Drogaria Do Município De Tanabi, São Paulo, Brasil

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