National Estimates of Emergency Department Visits for Antibiotic Adverse Events Among Adults—United States, 2011–2015

Geller, Andrew I.; Lovegrove, Maribeth C.; Shehab, Nadine; Hicks, Lauri A.; Sapiano, Mathew R. P.; Budnitz, Daniel S.

doi:10.1007/s11606-018-4430-x

Cited by 47 publications

(48 citation statements)

References 30 publications

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“…nausea, diarrhea or rash) to life-threatening (e.g. anaphylaxis, C. difficile infection (CDI)) [2][3][4][5] . Globally, it is estimated that nearly 700,000 people die annually, and 12,000 in the United Kingdom (UK) alone, as a direct result of resistant infections 6 and the economic burden of antimicrobial resistance (AMR) is estimated to range from $20,000 to $2,15,000 United States Dollar (USD) per case, with a predicted $3 trillion USD in global gross domestic product (GDP) loss by 2050 7 .…”

Section: Introductionmentioning

confidence: 99%

Application of a simple point-of-care test to reduce UK healthcare costs and adverse events in outpatient acute respiratory infections

Schneider

Boehme

Borisch³

et al. 2020

Journal of Medical Economics

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Background: Acute respiratory infection (ARI) accounts for over two-thirds of total antibiotic prescriptions although most are caused by viruses that do not benefit from antibiotics. Most antibiotics are prescribed in the outpatients setting. Antibiotic overuse leads to antibiotic-related adverse events (AEs), inclusive of secondary infections, resistance, and increased costs. Point-of-care tests (POCT) may reduce unnecessary antibiotics. A cost analysis was performed to assess diagnostic POCT options to identify patients with an ARI that may benefit from antibiotics in a United Kingdom (UK) outpatient setting. Methods: Healthcare savings were estimated using a budget impact analysis based on UK National Institute for Health and Care Excellence (NICE) data and direct costs (antibiotics, AEs, POCTs) derived from published literature. Otitis media, sinusitis, pharyngitis and bronchitis were considered the most common ARIs. Antibiotic-related AE costs were calculated using re-consultation costs for anaphylaxis, Stevens-Johnson syndrome, allergies/diarrhea/nausea, C. difficile infection (CDI). Potential cost-savings from POCTs was assessed by evaluating NICE guideline-referenced POCTs (CRP, FebriDx, Sarasota, FL) as well as a target product profile (TPP). Results: Fifty-percent (7,718,283) of ARI consultations resulted in antibiotics while guideline-based prescribing suggest appropriate antibiotic prescriptions are warranted 9% (1,444,877) of ARI consultations. Direct antibiotic costs for actual ARI consultations associated with antibiotics was £24,003,866 vs. £4,493,568 for guideline-based, "appropriate" antibiotic prescriptions. Antibiotic-related AEs and re-consultations for actual vs. appropriate prescribing totaled £302,496,486 vs. £63,854,269. ARI prescribing plus AE costs totaled £326,729,943 annually without the use of delayed prescribing practices or POCT while the addition of delayed prescribing plus POCT totaled £60,114,564-£78,148,933 depending on the POCT. Conclusions: Adding POCT to outpatient triage of ARI can reduce unnecessary antibiotics and antibiotic-related AEs, resulting in substantial cost savings. Further, near patient diagnostic testing can benefit health systems and patients by avoiding exposure to unnecessary drugs, side effects and antibiotic resistant pathogens. KEY POINTS FOR DECISION MAKERS Many patients are unnecessarily treated with antibiotics for respiratory infections. Antibiotic misuse leads to unnecessary adverse events, secondary infections, re-consultations, antimicrobial resistance and increased costs. Point-of-care diagnostic tests used to guide antibiotic prescriptions will avoid unnecessary adverse health effects and expenses.

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Section: Introductionmentioning

confidence: 99%

Application of a simple point-of-care test to reduce UK healthcare costs and adverse events in outpatient acute respiratory infections

Schneider

Boehme

Borisch³

et al. 2020

Journal of Medical Economics

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“…Rashes and pruritus were the commonly documented adverse reactions across all antibiotics and majority is due to sulfonamides. [7] With the advent of antimicrobial stewardship, combating the overuse of antibiotics and dealing with increasing resistance rates, it is essential to determine if there are other efficacious alternative options to antibiotics in the treatment of uncomplicated lower urinary tract infections.…”

Section: Introductionmentioning

confidence: 99%

Symptomatic treatment (using NSAIDS) versus antibiotics in uncomplicated lower urinary tract infection: a meta-analysis and systematic review of randomized controlled trials

Lopez

Tan

Yabon

et al. 2020

Preprint

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Background: Current guidelines recommend empiric antibiotics as first-line treatment for uncomplicated UTI. Despite proven benefits in treatment, antibiotic resistance rates still rise. Objectives: This meta-analysis aims to determine whether NSAIDs can serve as an effective and safe option in the treatment of uncomplicated lower UTI among non-pregnant women compared to antibiotics. Data Sources: PUBMED,MEDLINE,EMBASE,CENTRAL,ACP databases and other grey literature sources from inception to June 2019 were sought in the relevant search. Study Eligibility Criteria, Participants and Intervention: Randomized controlled trials that compare the use of NSAIDs versus antibiotics in non-pregnant women ≥ 18 years old with uncomplicated urinary tract infection. Methods: Primary outcomes were symptom resolution of UTI at Day 3 or 4 of intervention,and upper UTI complications. Secondary outcomes include persistence of positive urine culture despite treatment and need for another rescue antibiotic. Random and fixed-effects model for dichotomous data using Mantel-Haenszel and Peto odds method were reported at 95% CI followed by sensitivity analysis with substantial heterogeneity. Results: The probability of having a symptom resolution by Day 3 or 4 with NSAID use is only less than three-fourths of that with antibiotic treatment(RR: 0.69; 95% CIs [0.55, 0.86], I 2 =73).The odds of developing upper UTI complications with use of NSAIDs are 6.49 to 1 for antibiotics (Peto OR: 6.49, 95% CIs [3.02, 13.92], I 2 =0%).Secondary analysis showed that the NSAID group is 2.77x more likely to have persistence of a positive microbiologic urine culture than the antibiotic group (RR: 2.77; 95% CIs [1.95, 3.94], I 2 =36%).Treatment with NSAIDs are three times more likely to use a secondary or rescue antibiotic due to persistent or worsening symptoms as compared to antibiotics (RR: 3.10; 95% Cis [2.17, 4.43], I 2 =53%). Conclusion: This meta-analysis could not prove non-inferiority of NSAIDs over antibiotics. However,the authors would still recommend maintaining the use of empiric antibiotic therapy as the primary treatment for UTI because of limited NSAID benefits with complication risks.

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“…clinical characteristics of adverse events (AEs) related to antibiotics using public health surveillance and dispensed prescription data. 1 Between 2011 and 2015, there were 145,490 ED visits for antibiotic-related AEs. Oral sulfonamides were the most commonly implicated antibiotic class, followed by penicillins and quinolones.…”

mentioning

confidence: 99%

“…Mild allergic reactions were the most common AEs, occurring most often in sulfonamides. 1 The paper does not explore the number of AEs that resulted in hospitalization, which would have provided greater context about the severity of the events encountered. Interestingly, the authors note that their findings are similar to those of a study completed a decade ago.…”

mentioning

confidence: 99%

“…As the authors note, this younger population is a group that may be particularly amenable to discussion about the dangers of antibiotic use. 1 The use of antibiotics is a shared decision made between the provider and the patient with patient expectations for antibiotics often contributing to overuse. Providers may be able to use the data from this study to have more enlightened discussions with patients.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Capsule commentary on Geller et al., National estimates of emergency department visits for antibiotic adverse events among adults—United States, 2011–2015

Blanchard

2018

J GEN INTERN MED

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National Estimates of Emergency Department Visits for Antibiotic Adverse Events Among Adults—United States, 2011–2015

Cited by 47 publications

References 30 publications

Application of a simple point-of-care test to reduce UK healthcare costs and adverse events in outpatient acute respiratory infections

Application of a simple point-of-care test to reduce UK healthcare costs and adverse events in outpatient acute respiratory infections

Symptomatic treatment (using NSAIDS) versus antibiotics in uncomplicated lower urinary tract infection: a meta-analysis and systematic review of randomized controlled trials

Capsule commentary on Geller et al., National estimates of emergency department visits for antibiotic adverse events among adults—United States, 2011–2015

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