Reduced antibiotic prescribing for acute respiratory infections in adults and children

Abstract

Resistance to antibacterial medications among community-acquired pathogens is a growing public health threat. [1][2][3][4][5] Key drivers are the volume and type of antibacterials used in ambulatory settings. [6][7][8] Antibacterials are often prescribed for acute nonspecific respiratory infections (ARIs), which they are unlikely to benefit. 9,10 Reducing such use can slow, or even reverse resistance rates. British Journal of General Practice, October 2009 e321 Reduced antibiotic prescribing for acute respiratory infections in adults and children Sharon B Meropol, Zhen Chen and Joshua P Metlay SB Meropol, Z Chen and JP Metlay ABSTRACT BackgroundRecent public health efforts, including in the UK and US, have targeted decreasing unnecessary antibiotic use. In the US, prescribing for acute non-specific respiratory infections (ARIs) has decreased, but broadspectrum antibacterial prescribing has soared. AimTo assess recent trends in antibacterial prescribing for ARIs in the UK. Design of studyRetrospective cohort. SettingThe Health Improvement Network database. MethodOutpatient ARI visits from 1 January 1990 to 31 December 2004 were selected. Outcomes were antibacterial and broad-spectrum antibacterial prescriptions per thousand person-years, and the probability of receiving an antibacterial and broadspectrum prescription conditional on an ARI visit. ResultsFrom 1990 to 2004, antibacterial prescribing rates for ARIs decreased from 55.0 to 30.3 prescriptions/1000 person-years for adults and from 124.8 to 46.3 prescriptions/1000 person-years for children (P = 0.001). The probability of receiving an antibacterial prescription after an ARI visit decreased from 70.8% to 59.5% for adults and from 46.1% to 30.8% for children (P = 0.003 and 0.007, respectively). Antibacterial prescribing declined faster for younger than for older adults. Broad-spectrum antibacterial prescribing rates decreased from 3.8 to 2.9 prescriptions/1000 personyears for adults and from 5.2 to 2.2 prescriptions/1000 person years for children (P = 0.005 and 0.003, respectively). The probability of broad-spectrum prescribing did not demonstrate a significant linear trend for adults (P = 0.16), and decreased for children (P = 0.01). ConclusionUK antibacterial prescribing for ARIs has declined, similar to US trends, but there was no concomitant increase in low broad-spectrum prescribing. The success of UK strategies for limiting antimicrobial use has implications for programmes in other countries.

Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery

“…7 In the 1990s, antibiotic prescriptions for children reduced by almost one-third in the UK, US, and many European countries. 8,9 This reduction then plateaued and, although prescribing levels may be increasing slightly, they remain much lower than in the 1990s. 8,9 The problem of undiagnosed and untreated UTIs in children, therefore, may have become more common in light of the reduced prescribing of antibiotics in primary care to children who are acutely unwell.…”

“…8,9 This reduction then plateaued and, although prescribing levels may be increasing slightly, they remain much lower than in the 1990s. 8,9 The problem of undiagnosed and untreated UTIs in children, therefore, may have become more common in light of the reduced prescribing of antibiotics in primary care to children who are acutely unwell. The proportion of children who have a UTI diagnosed on urine culture who are not suspected of having a UTI in the normal course of primary care has been unclear.…”

Antimicrobial prescribing pattern in the treatment of acute respiratory tract infections in children in a tertiary care hospital

“…However, antibiotics are often used for the treatment of many acute respiratory infections episodes including nonspecific symptoms such as sore throat, common cold and rhinitis or bronchospasm, for which there is an unlikely therapeutic benefit. [5][6][7][8][9] In some cases, the symptoms are highly suggestive of a bacterial origin or with signs of severity or a pre-existing co-morbidity predisposing to bacterial infections, clearly justifies the use of antibacterial agents. Antibiotic treatment is beneficial to children only if symptoms persist for 10-14 days without improvement.…”

The future role of pharmacists in primary care

“…10 Similar concerns have been expressed in the past about whether pharmacists are applying evidence to the dispensing of over-the-counter medicines; for example, topical antifungals in vaginal candidiasis. 11 Watson et al described an educational initiative which presented an evidence-based guideline accompanied by educational outreach visits or continuing-professional-education sessions to improve the application of evidence by pharmacists, but its implementation had a disappointing lack of impact.…”