Principles of Appropriate Antibiotic Use for Treatment of Acute Bronchitis in Adults

Snow, Vincenza; Mottur‐Pilson, Christel; Gonzales, Ralph

doi:10.7326/0003-4819-134-6-200103200-00020

Cited by 105 publications

(62 citation statements)

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“…This practice may be indicative of a suspicion of underlying bacterial illness (15). However, guidelines and reviews commonly recommend against this method of management, as studies have shown that antibiotic prescription for acute bronchitis is minimally effective, resulting in a half-day reduction in cough but no reduction in functional impairment compared to the placebo and resulting in increased adverse events (13,49,50).…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections

McKay

Mah

Law

et al. 2016

Antimicrob Agents Chemother

174

153

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Antibiotic use is a modifiable driver of antibiotic resistance. In many circumstances, antibiotic use is overly broad or unnecessary. We systematically assessed factors associated with antibiotic prescribing for respiratory tract infections (RTI). Studies were included if they used actual (not self-reported or intended) prescribing data, assessed factors associated with antibiotic prescribing for RTIs, and performed multivariable analysis of associations. We searched Medline, Embase, and International Pharmaceutical Abstracts using keyword and MeSH (medical subject headings) search terms. Two authors reviewed each abstract and independently appraised all included texts. Data on factors affecting antibiotic prescribing were extracted. Our searches retrieved a total of 2,848 abstracts, with 97 included in full-text review and 28 meeting full inclusion criteria. Compared to other factors, diagnosis of acute bronchitis was associated with increased antibiotic prescribing (range of adjusted odds ratios [aOR], 1.56 to 15.9). Features on physical exam, such as fever, purulent sputum, abnormal respiratory exam, and tonsillar exudate, were also associated with higher odds of antibiotic prescribing. Patient desire for an antibiotic was not associated or was modestly associated with prescription (range of aORs, 0.61 to 9.87), in contrast to physician perception of patient desire for antibiotics, which showed a stronger association (range of aORs, 2.11 to 23.3). Physician's perception of patient desire for antibiotics was strongly associated with antibiotic prescribing. Antimicrobial stewardship programs should continue to expand in the outpatient setting and should emphasize clear and direct communication between patients and physicians, as well as signs and symptoms that do and do not predict bacterial etiology of upper respiratory tract infections.T he rapid and ongoing spread of antimicrobial-resistant organisms threatens our ability to successfully treat a growing number of infectious diseases (1, 2). It is well established that antibiotic use is a significant, and modifiable, driver of antibiotic resistance (3-5), and that antibiotics are often misused (6). In settings where a prescription is required to access antibiotics, the prescriber-patient encounter is a logical target for improving appropriate use.Despite the importance of the topic, there is no existing systematic review to identify drivers of antibiotic prescribing from real prescription data. A narrative review of factors influencing antibiotic prescribing highlighted the multiple sources of influence affecting a potential prescribing encounter, including factors related to the prescribing physician (e.g., fear of failure, diagnostic uncertainty, or inadequate training), the patient (e.g., a high-risk or vulnerable patient history), and the environment (e.g., regulation of pharmaceutical prescribing and dispensing and lack of resources for etiological diagnosis) (7). Another study systematically reviewed reasons for inappropriate antibiotic prescriptions, f...

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Section: Discussionmentioning

confidence: 99%

Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections

McKay

Mah

Law

et al. 2016

Antimicrob Agents Chemother

174

153

View full text Add to dashboard Cite

show abstract

“…Perhaps, more importantly, the guideline for acute bronchitis indicates that the evaluation of adults with an acute cough illness or presumptive acute bronchitis must first focus on ruling out serious illness like pneumonia. 5,6 Thus, it is unclear whether an unintended consequence of a strategy to decrease antibiotic resistance has been to decrease the use of antibiotics in cases where antibiotics might be beneficial.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Prescribing of antibiotics for acute bronchitis has been the focus of guidelines designed to decrease prescribing for this condition and thereby decrease antibiotic resistance. 5,6 The guideline endorsed by the Centers for Disease Control and Prevention, the American Academy of Family Physicians, the American College of Physicians, American Society or Internal Medicine, and the Infectious Diseases Society of America recommended that antibiotic treatment of uncomplicated acute bronchitis should not be given routinely, regardless of duration of cough. However, the Cochrane review of the trials of treatment for acute bronchitis as well as several other meta-analyses have indicated that antibiotics have a moderate beneficial effect in the treatment of acute bronchitis.…”

Section: Introductionmentioning

confidence: 99%

Ambulatory Antibiotic Prescribing for Acute Bronchitis and Cough and Hospital Admissions for Respiratory Infections: Time Trends Analysis

et al. 2006

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Objectives To examine the relationship between ambulatory antibiotic prescribing for acute bronchitis and cough with hospital admissions for respiratory infections in the USA between 1996 and 2003. Design Analysis of data on antibiotic prescribing for episodes of acute bronchitis/cough illness in ambulatory care and hospitalization for respiratory infections for adults between 1996 and 2003 in the USA.

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“…2,3 Although excessive use of antibiotics has contributed to the spread of antibiotic resistance, [4][5][6] most initiatives regarding inappropriate direct human consumption of therapeutic antibiotics focus almost exclusively on controlling prescribing by health care clinicians. 1,4,[7][8][9][10] As a result, most estimates of the reservoir of antibiotics in the community are based on evaluations of clinician-prescribing behavior.…”

Section: Introductionmentioning

confidence: 99%

Availability of Antibiotics for Purchase Without a Prescription on the Internet

Mainous¹,

Everett²,

Rm³

et al. 2009

The Annals of Family Medicine

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PURPOSE Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient selfmedication. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. METHODSWe conducted an Internet search using 2 major search engines (Google and Yahoo) with the key words "purchase antibiotics without a prescription" and "online (English only)." Vendors were compared according to the classes of antibiotics available, quantity, shipping locations, and shipping time. RESULTSWe found 138 unique vendors selling antibiotics without a prescription. Of those vendors, 36.2% sold antibiotics without a prescription, and 63.8% provided an online prescription. Penicillins were available on 94.2% of the sites, macrolides on 96.4%, fl uoroquinolones on 61.6%, and cephalosporins on 56.5%. Nearly all, 98.6%, ship to the United States. The mean delivery time was 8 days, with 46.1% expecting delivery in more than 7 days. Among those selling macrolides (n = 133), 93.3% would sell azithromycin in quantities consistent with more than a single course of medication. Compared with vendors that require a medical interview, vendors who sell antibiotics without a prescription were more likely to sell quantities in excess of a single course, and the antibiotics were more likely to take more than 7 days to reach the customer.CONCLUSIONS Antibiotics are freely available for purchase on the Internet without a prescription, a phenomenon that encourages self-medication and low quality of care. INTRODUCTIONA ntibiotics serve a useful therapeutic purpose in treating and controlling the impact of pathogens. Antibiotic resistance is a global problem, however, and has been described with numerous pathogens and in varying contexts.1 Because of its effect on morbidity and mortality, antibiotic resistance is considered a threat to US public health and national security by the Institute of Medicine and the Infectious Diseases Society of America. 2,3Although excessive use of antibiotics has contributed to the spread of antibiotic resistance, 4-6 most initiatives regarding inappropriate direct human consumption of therapeutic antibiotics focus almost exclusively on controlling prescribing by health care clinicians.1,4,7-10 As a result, most estimates of the reservoir of antibiotics in the community are based on evaluations of clinician-prescribing behavior.Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the [16][17][18][19] Patients are increasingly using the Internet not only to access health information but also to obtai...

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Principles of Appropriate Antibiotic Use for Treatment of Acute Bronchitis in Adults

Cited by 105 publications

References 1 publication

Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections

Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections

Ambulatory Antibiotic Prescribing for Acute Bronchitis and Cough and Hospital Admissions for Respiratory Infections: Time Trends Analysis

Availability of Antibiotics for Purchase Without a Prescription on the Internet

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