Antibiotic Prescribing for Nonbacterial Acute Upper Respiratory Infections in Elderly Persons

Silverman, Michael; Povitz, Marcus; Sontrop, Jessica M.; Li, Lihua; Richard, Lucie; Cejic, Sonny; Shariff, Salimah Z.

doi:10.7326/m16-1131

Cited by 105 publications

(108 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We did not examine specific provider factors beyond clinical service. However, previous studies have found that physician specialty, age or level of career, gender, patient volume, and country of training were associated with antibiotic prescribing for URIs [8,9,11,28].…”

Section: Discussionmentioning

confidence: 84%

“…Finally, we did not formally review each antibiotic prescription for the URI to assess appropriateness. However, we chose diagnosis codes that correspond to conditions for which antibiotics would generally be considered inappropriate, which is consistent with the approach taken in other studies [3,[7][8][9][10][11][12][13]. In addition, we reviewed diagnoses of sinusitis and found that appropriate use [6,29] in these cases contributed minimally to total antibiotic use in the cohort.…”

Section: Discussionmentioning

confidence: 98%

“…As such, the Centers for Disease Control and Prevention and other national organizations have highlighted antibiotic use for acute URIs as a key target for antimicrobial stewardship [4][5][6]. Most studies that describe antibiotic prescribing for acute URIs have focused on general medical or pediatric populations [3,[7][8][9][10][11][12][13]. Little is known about antibiotic prescribing practices for URIs among ambulatory cancer patients.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Antibiotic Prescribing and Respiratory Viral Testing for Acute Upper Respiratory Infections Among Adult Patients at an Ambulatory Cancer Center

Krantz

Zier

Stohs

et al. 2019

Clinical Infectious Diseases

View full text Add to dashboard Cite

Background. Outpatient antibiotic prescribing for acute upper respiratory infections (URIs) is a high-priority target for antimicrobial stewardship that has not been described for cancer patients.Methods. We conducted a retrospective cohort study of adult patients at an ambulatory cancer center with URI diagnoses from 1 October 2015 to 30 September 2016. We obtained antimicrobial prescribing, respiratory viral testing, and other clinical data at first encounter for the URI through day 14. We used generalized estimating equations to test associations of baseline factors with antibiotic prescribing.Results. Of 341 charts reviewed, 251 (74%) patients were eligible for analysis. Nearly one-third (32%) of patients were prescribed antibiotics for URIs. Respiratory viruses were detected among 85 (75%) of 113 patients tested. Antibiotic prescribing (P = .001) and viral testing (P < .001) varied by clinical service. Sputum production or chest congestion was associated with higher risk of antibiotic prescribing (relative risk [RR], 2.3; 95% confidence interval [CI], 1.4-3.8; P < .001). Viral testing on day 0 was associated with lower risk of antibiotic prescribing (RR, 0.4; 95% CI 0.2-0.8; P = .01), though collinearity between viral testing and clinical service limited our ability to separate these effects on prescribing.Conclusions. Nearly one-third of hematology-oncology outpatients were prescribed antibiotics for URIs, despite viral etiologies identified among 75% of those tested. Antibiotic prescribing was significantly lower among patients who received an initial respiratory viral test. The role of viral testing in antibiotic prescribing for URIs in outpatient oncology settings merits further study.

show abstract

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

See 1 more Smart Citation

Antibiotic Prescribing and Respiratory Viral Testing for Acute Upper Respiratory Infections Among Adult Patients at an Ambulatory Cancer Center

Krantz

Zier

Stohs

et al. 2019

Clinical Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…Another strength of our study was the high number of postgraduate years of the participants. The more years in a doctor's experience, the more likely he/she is to prescribe inappropriate antibiotics for viral RTIs . It is noteworthy that this course was both satisfactory and helpful for experienced doctors, who were the relevant target population of such a workshop.…”

Section: Discussionmentioning

confidence: 93%

Development and efficacy of a clinician‐targeted refresher course for treating nonpneumonia respiratory tract infections

Yamamoto

Fujitomo

et al. 2018

J of Gen and Family Med

View full text Add to dashboard Cite

BackgroundIn 2017, the Japanese government published an evidence‐based manual describing the appropriate use of antibiotics in outpatient settings to tackle the problem of antimicrobial resistance. To fill the evidence‐practice gap, we developed a clinician‐targeted course aimed at improving clinician skills in the daily clinical practice of treating acute respiratory tract infections (RTIs) based on the manual. The aim of this study was to evaluate the efficacy of the course.MethodsThis course consisted of lectures using illness scripts and checklists, as well as interactive communication skills training using role‐playing. We performed a vignette‐based evaluation of the changes in the knowledge and attitudes of the course participants toward prescribing antibiotics for nonpneumonia RTIs, using pre‐ and postcourse questionnaires. The questionnaires also included course feedback via the use of a 5‐point Likert scale.ResultsThirty‐eight clinicians were included in the analyses, and 90% of these participants had graduated ≥20 years ago. We found statistically significant reductions in the intention to prescribe antibiotics for four of the six nonpneumonia RTI vignettes: acute bronchitis (−47.2%; 95% confidence interval [CI] −66.3 to −28.1%), common cold (−16.2%; 95% CI −30.8 to −1.6%), acute pharyngitis (−27.0%; 95% CI −49.0 to −5.0%), and acute rhinosinusitis (−33.3%; 95% CI −53.3 to −13.3%). The course seemed to be satisfactory for experienced doctors who were the relevant target population of such a workshop.ConclusionsThe refresher course was helpful for reducing the participants’ intensions to prescribe antibiotics for nonpneumonia RTIs.

show abstract

“…In 2010-11, 18% of prescriptions in doctors' offices and emergency departments for adults aged 65 and older were considered unnecessary 25 , and overuse of macrolides for respiratory tract infections is well documented in adults 26 . Antibiotics were inappropriately prescribed for 46% of low-risk older adults presenting with nonbacterial acute upper respiratory tract infections, and 70% of prescriptions were for broad-spectrum agents, such as macrolides 27 . Appropriate antibiotic use is particularly important because of the high risk of adverse drug events and complications that can result from drug-drug interactions in this age group 6,8 .…”

Section: Discussionmentioning

confidence: 99%

Outpatient Antibiotic Prescribing for Older Adults in the United States: 2011 to 2014

Kabbani

Palms

Bartoces

et al. 2018

J American Geriatrics Society

View full text Add to dashboard Cite

On average, in 2014, U.S. adults aged 65 and older received enough outpatient antibiotic courses for every older adult to receive at least 1. Quinolones and azithromycin are potential targets for assessing the appropriateness of antibiotic prescribing in this population. Interventions to improve use targeting internists and family physicians in the South Census region might have the potential to have the greatest effect.

show abstract

Antibiotic Prescribing for Nonbacterial Acute Upper Respiratory Infections in Elderly Persons

Abstract: Ontario Ministry of Health and Long-term Care, Academic Medical Organization of Southwestern Ontario, Schulich School of Medicine and Dentistry, Western University, and Lawson Health Research Institute.

Cited by 105 publications

References 48 publications

Antibiotic Prescribing and Respiratory Viral Testing for Acute Upper Respiratory Infections Among Adult Patients at an Ambulatory Cancer Center

Antibiotic Prescribing and Respiratory Viral Testing for Acute Upper Respiratory Infections Among Adult Patients at an Ambulatory Cancer Center

Development and efficacy of a clinician‐targeted refresher course for treating nonpneumonia respiratory tract infections

Outpatient Antibiotic Prescribing for Older Adults in the United States: 2011 to 2014

Contact Info

Product

Resources

About