Antibiotic prescribing for respiratory tract complaints in Malta: a 1 year repeated cross-sectional surveillance study

Saliba‐Gustafsson, Erika A.; Hampton, Alexandra Dunberger; Zarb, Peter; Borg, Michael; Lundborg, Cecilia Stålsby

doi:10.1093/jac/dky544

Cited by 6 publications

(18 citation statements)

References 32 publications

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“…A study protocol with a detailed description of the study setting and design has already been published 19. An in-depth description of GPs’ antibiotic prescribing patterns at baseline, using the same surveillance data but with slightly different eligibility criteria, has been presented elsewhere 5…”

Section: Methodsmentioning

confidence: 99%

“…Forms were completed by the GPs themselves during the first consultation with patients of all ages suffering from any aRTC (defined as lower and upper respiratory tract infections, allergies and exacerbation of chronic obstructive pulmonary disease (COPD)/asthma/bronchitis), and included information on patient and clinical factors, clinical assessment, diagnosis and prescribed medicines. The surveillance data collection form has been published elsewhere 5. Data on the total number of patients seen each day, regardless of complaint, were also collected.…”

Section: Methodsmentioning

confidence: 99%

“…Most antibiotic prescriptions are provided in outpatient care, with respiratory tract infections being the most common diagnoses 3. Studies have shown that up to 78% of patients are prescribed antibiotics for respiratory tract infections in primary care, even though an estimated 90% are viral in aetiology and thus antibiotics are seldom required 4–8. Indeed, unless pneumonia is suspected, the effect of antibiotic treatment is moderate at best indicating that many antibiotic prescriptions are provided unnecessarily and without any overall patient benefit 9.…”

Section: Introductionmentioning

confidence: 99%

“…Non-prescribed use was minimal at 4% 16. Our recently published descriptive study based on surveillance data showed that, in 2015/2016, 46% of patients with acute respiratory tract complaints (aRTCs) were prescribed antibiotics by their GP 5. The top three diagnoses that received an antibiotic prescription were tonsillitis (96%), otitis media (93%) and bronchitis (88%), and the most commonly prescribed antibiotics were macrolides (36%) and penicillins with a β-lactamase inhibitor (33%) 5.…”

Section: Introductionmentioning

confidence: 99%

“…Our recently published descriptive study based on surveillance data showed that, in 2015/2016, 46% of patients with acute respiratory tract complaints (aRTCs) were prescribed antibiotics by their GP 5. The top three diagnoses that received an antibiotic prescription were tonsillitis (96%), otitis media (93%) and bronchitis (88%), and the most commonly prescribed antibiotics were macrolides (36%) and penicillins with a β-lactamase inhibitor (33%) 5. Indeed, the majority of antibiotic consumption in Malta occurs in the community and comprises primarily broad-spectrum antibiotics (ie, tetracyclines, beta-lactam antibacterials, second-generation and third-generation cephalosporins, macrolides and fluoroquinolones) 5 17 18…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with antibiotic prescribing in patients with acute respiratory tract complaints in Malta: a 1-year repeated cross-sectional surveillance study

et al. 2019

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ObjectiveTo identify factors that influence general practitioners’ (GPs’) oral antibiotic prescribing for acute respiratory tract complaints (aRTCs) in Malta.DesignRepeated, cross-sectional surveillance.SettingMaltese general practice; both public health centres and private GP clinics.Participants30 GPs registered on the Malta Medical Council’s Specialist Register and 3 GP trainees registered data of 4831 patients of all ages suffering from any aRTC. Data were collected monthly between May 2015 and April 2016 during predetermined 1-week periods.Outcome measuresThe outcome of interest was antibiotic prescription (yes/no), defined as an oral antibiotic prescription issued for an aRTC during an in-person consultation, irrespective of the number of antibiotics given. The association between GP, practice and consultation-level factors, patient sociodemographic factors and patient health status factors, and antibiotic prescription was investigated.ResultsThe antibiotic prescription rate was 45.0%. Independent factors positively associated with antibiotic prescribing included female GP sex (OR 2.3, 95% CI 1.22 to 4.26), GP age with GPs ≥60 being the most likely (OR 34.7, 95% CI 14.14 to 84.98), patient age with patients ≥65 being the most likely (OR 2.3, 95% CI 1.71 to 3.18), number of signs and/or symptoms with patients having ≥4 being the most likely (OR 9.6, 95% CI 5.78 to 15.99), fever (OR 2.6, 95% CI 2.08 to 3.26), productive cough (OR 1.3, 95% CI 1.03 to 1.61), otalgia (OR 1.3, 95% CI 1.01 to 1.76), tender cervical nodes (OR 2.2, 95% CI 1.57 to 3.05), regular clients (OR 1.3, 95% CI 1.05 to 1.66), antibiotic requests (OR 4.8, 95% CI 2.52 to 8.99) and smoking (OR 1.4, 95% CI 1.13 to 1.71). Conversely, patients with non-productive cough (OR 0.3, 95% CI 0.26 to 0.41), sore throat (OR 0.6, 95% CI 0.53 to 0.78), rhinorrhoea (OR 0.3, 95% CI 0.23 to 0.36) or dyspnoea (OR 0.6, 95% CI 0.41 to 0.83) were less likely to receive an antibiotic prescription.ConclusionAntibiotic prescribing for aRTCs was high and influenced by a number of factors. Potentially inappropriate prescribing in primary care can be addressed through multifaceted interventions addressing modifiable factors associated with prescription.Trial registration number NCT03218930

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors associated with antibiotic prescribing in patients with acute respiratory tract complaints in Malta: a 1-year repeated cross-sectional surveillance study

et al. 2019

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Antibiotic consumption for sore throat and the potential effect of a vaccine against group A Streptococcus: a systematic review and modelling study

Miller,

Barnett,

Cadarette

et al. 2023

eBioMedicine

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General practitioners’ perceptions of delayed antibiotic prescription for respiratory tract infections: A phenomenographic study

et al. 2019

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BackgroundAntibiotic use is a major driver of antibiotic resistance. Although delayed antibiotic prescription is a recommended strategy to reduce antibiotic use, practices vary; it appears less commonly used in southern European countries where antibiotic consumption is highest. Despite these variations, few qualitative studies have explored general practitioners’ perceptions of delayed antibiotic prescription. We therefore aimed to explore and describe the perceptions of delayed antibiotic prescription for respiratory tract infections among general practitioners in Malta.MethodsThis qualitative phenomenographic study was conducted in Malta. A semi-structured interview guide was developed in English, pilot tested and revised accordingly. Interview topics included views on antibiotic resistance, antibiotic use and delayed antibiotic prescription for respiratory tract infections, and barriers and facilitators to antibiotic prescription. Individual, face-to-face interviews were held in 2014 with a quota sample of 20 general practitioners and transcribed verbatim. Data were subsequently analysed using a phenomenographic approach.FindingsGeneral practitioners perceived delayed antibiotic prescription in five qualitatively different ways: (A) “The Service Provider”–maintaining a good general practitioner-patient relationship to retain patients and avoid doctor-shopping, (B) “The Uncertainty Avoider”–reaching a compromise and providing treatment just in case, (C) “The Comforter”–providing the patient comfort and reassurance, (D) “The Conscientious Practitioner”–empowering and educating patients, and limiting antibiotic use, and (E) “The Holder of Professional Power”–retaining general practitioner responsibility by employing a wait-and-see approach. Although general practitioners were largely positive towards delayed antibiotic prescription, not all supported the strategy; some preferred a wait-and-see approach with follow-up. Many delayed antibiotic prescription users selectively practiced delayed prescription with patients they trusted or who they believed had a certain level of knowledge and understanding. They also preferred a patient-led approach with a one to three day delay; post-dating delayed antibiotic prescriptions was uncommon.ConclusionsIn this study we have shown that general practitioners hold varying perceptions about delayed antibiotic prescription and that there is variation in the way delayed antibiotic prescription is employed in Malta. Whilst delayed antibiotic prescription is utilised in Malta, not all general practitioners support the strategy, and motivations and practices differ. In high consumption settings, formal and standardised implementation of delayed antibiotic prescription could help curb antibiotic overuse. Diagnosis-specific delayed antibiotic prescription recommendations should also be incorporated into guidelines. Finally, further investigation into patients’ and pharmacists’ views on delayed antibiotic prescription is required.Trial registration numberNCT03218930

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Antibiotic prescribing for respiratory tract complaints in Malta: a 1 year repeated cross-sectional surveillance study

Cited by 6 publications

References 32 publications

Factors associated with antibiotic prescribing in patients with acute respiratory tract complaints in Malta: a 1-year repeated cross-sectional surveillance study

Factors associated with antibiotic prescribing in patients with acute respiratory tract complaints in Malta: a 1-year repeated cross-sectional surveillance study

Antibiotic consumption for sore throat and the potential effect of a vaccine against group A Streptococcus: a systematic review and modelling study

General practitioners’ perceptions of delayed antibiotic prescription for respiratory tract infections: A phenomenographic study

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