A Sustainable Strategy to Prevent Misuse of Antibiotics for Acute Respiratory Infections

Abstract

BackgroundsOver 50% of antibiotics prescriptions are for outpatients with acute respiratory infections (ARI). Many of them are not needed and thus contribute both avoidable adverse events and pressures toward the development of bacterial resistance. Could a clinical decision support system (CDSS), interposed at the time of electronic prescription, adjust antibiotics utilization toward consensus treatment guidelines for ARI?MethodsThis is a retrospective comparison of pre- (2002) and post-intervention (2003–2006) periods at two comprehensive health care systems (intervention and control). The intervention was a CDSS that targeted fluoroquinolone and azithromycin; other antibiotics remained unrestricted. 7000 outpatients visits flagged by an ARI case-finding algorithm were reviewed for congruence with the guidelines (antibiotic prescribed-when-warranted or not-prescribed-when-unwarranted).Results3831 patients satisfied the case definitions for one or more ARI: pneumonia (537), bronchitis (2931), sinusitis (717) and non-specific ARI (145). All patients with pneumonia received antibiotics. The relative risk (RR) of congruent prescribing was 2.57 (95% CI = (1.865 to 3.540) in favor of the intervention site for the antibiotics targeted by the CDSS; congruence did not change for other antibiotics (adjusted RR = 1.18 (95% CI = (0.691 to 2.011)). The proportion of unwarranted prescriptions of the targeted antibiotics decreased from 22% to 3%, pre vs. post-intervention (p<0.0001).ConclusionsA CDSS interposed at the time of e-prescription nearly extinguished unwarranted use targeted antibiotics for ARI for four years. This intervention highlights a path toward sustainable antibiotics stewardship for outpatients with ARI.

A Medical Informatics Perspective on Clinical Decision Support Systems

“…This is an original application for clinical decision support, which could prevent many drug errors and reduce the clinicians' workload during admission. The third paper by Rattinger et al [5] evaluates a CDSS that secures antibiotic prescription for acute respiratory infections. Their experiment on CDSS-targeted antibiotic drugs showed a nearly elimination of unwarranted prescriptions.…”

“…Thanks to recent works in cognitive sciences, the process of the medical decision is better known. Finally, drug prescribing remains a domain where computerized decision support yields positive results by reducing prescription errors, thus improving patient safety [4,5,7,8]. As for the appraisal of the effectiveness of CDSSs in real settings, it is still reported that the conduct of interventions remains a difficult task [8].…”

Gambaran Farmakoterapi Pasien Common Cold Di Puskesmas Pekanbaru

“…Resistensi mikroorganisme terhadap antibiotik meningkatkan mortalitas, morbiditas dan peningkatan biaya akibat infeksi. 8,9 Studi metaanalisis juga menunjukkan bahwa tidak ada keuntungan penggunaan antibiotik pada common cold baik pada anak maupun dewasa. Penggunaan antibiotik yang rasional dapat mengurangi angka kejadian resistensi mikroorganisme dan timbulnya efek samping yang tidak diinginkan.…”

Antibiotic Misuse in Hospital, Outpatient, and Long-Term Care Settings

“…One study of treatment for acute respiratory infections showed that inappropriate prescriptions of the targeted antibiotic decreased from 22% to 3% when, upon order entry, a CDSS guided providers to the right indications for drug use [16]. Development of point-of-care rapid diagnostic tests that can distinguish viral infections from bacterial infections can also decrease antibiotic misuse in the outpatient setting [17].…”