Antibiotic Treatment of Acute Respiratory Infections in Acute Care Settings

Gonzales, Ralph; Camargo, Carlos A.; MacKenzie, Thomas D.; Kersey, Ayanna S.; Maselli, Judith; Levin, Sara K.; McCulloch, Charles E.; Metlay, Joshua P.

doi:10.1111/j.1553-2712.2006.tb01695.x

Cited by 44 publications

(47 citation statements)

References 25 publications

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“…In two studies from the United States, antibiotics were prescribed to more than 80% of patients with AECOPD [Lindenauer et al 2006;Gonzales et al 2006] and in a study from Australia, the antibiotic prescribing rate reached 87% [Pretto et al 2012]. Miravitlles and colleagues found that Spanish GPs prescribed antibiotics to 89% of patients with AECOPD [Miravitlles et al 1999].…”

Section: Discussionmentioning

confidence: 99%

Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice

Llor

Bjerrum

Munck

et al. 2013

Ther Adv Respir Dis

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Background: The aim of this study was to describe the antibiotic prescribing rate in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to analyse predictors for antibiotic prescribing and to explore the influence of the use C-reactive protein (CRP) rapid test. Methods: A cross-sectional study was carried out in January and February 2008 in primary care. General practitioners (GPs) from six countries (Denmark, Sweden, Lithuania, Russia, Spain and Argentina) registered all patients with AECOPD during a 3-week period. A multilevel logistic regression model was estimated using two hierarchical levels, (i) patients and (ii) physicians, and was used to analyse the association between antibiotic prescribing and potential predictors for antibiotic use: patients' age and gender, duration and symptoms and signs of exacerbations (fever, cough, dyspnoea, sputum volume and purulence) and the results of the CRP test. Results: A total of 617 GPs registered 1233 patients with AECOPD. A total of 970 patients (79%) were prescribed antibiotics, varying from 49% (Denmark) to 93% (Russia). The presence of purulent sputum was the strongest predictor for antibiotic treatment (odds ratio [OR] 8.7; 95% confidence interval [CI] 5.9-12.8). CRP determination was carried out mainly in Denmark and Sweden and its use was the strongest protective factor for antibiotic therapy (OR 0.3; 95% CI 0.2-0.6). GPs that used CRP testing weighted purulent sputum lower than GPs who did not use CRP testing. CRP values had a strong influence on the antibiotic prescribing rate. Conclusions: Antibiotic treatment for AECOPD is very high. This study shows that GPs performing CRP rapid tests prescribe fewer antibiotics than those who do not.

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Section: Discussionmentioning

confidence: 99%

Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice

Llor

Bjerrum

Munck

et al. 2013

Ther Adv Respir Dis

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“…67 Antibiotic prescribing practices were generally similar between seven VA and seven non-VA emergency departments; however, in the three cities in which prescription rates were not comparable between VA and non-VA sites, VA sites had much higher rates of antibiotic prescriptions. 68 Availability of Services. The structure of women's health care differed at eight VA women's health centers and 13 Department of Health and Human Services Centers of Excellence.…”

Section: Safetymentioning

confidence: 99%

Comparing VA and Non-VA Quality of Care: A Systematic Review

et al. 2016

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“…Emergency providers are often cited as the worst offenders of the overuse of antibiotics [10]. Reasons given for these cited differences include: patients in the ED may be worse, may be less likely to have insurance, may lack access to good medical follow-up, and may have different expectations regarding the need and desire for antibiotics than those in primary care [11].…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Antibiotic Prescribing for Acute Respiratory Infection by Emergency Physicians

Safdar¹,

Tape²,

Fox³

et al. 2014

Health

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Background: Antibiotics are frequently prescribed for upper acute respiratory tract infections (ARI) in the emergency department. To reduce inappropriate overprescribing, it is necessary to understand factors influencing physicians' decisions to prescribe antibiotics. Objective: Analyze the judgment policies of emergency physicians to determine factors predicting antibiotic use. Design: Paper case vignette study. Participants: 104 emergency physicians from Wisconsin. Measurements: We used judgment analysis to derive the policies of 104 emergency physicians from their responses to 20 case vignettes. We designed the cases such that each physician's use of clinical findings and patient factors could be inferred from the decisions they made about each case. Findings were compared to primary care practitioners (PCPs) in Colorado responding to the same paper cases to examine differences in factors influencing prescribing among the two groups. Results: The emergency physicians said they would prescribe an antibiotic (yes/no) in 51.4% of cases compared with 44.5% in the Colorado study. The majority of emergency physicians gave the greatest weight to duration of illness (51%), followed by temperature (20%) and cough (12%). Conclusions: These emergency physicians prescribed antibiotics more frequently than the Colorado PCPs. There was little difference in how clinical findings were weighted, suggesting this was not the source of the higher prescription rate among the emergency physicians. The considerable emphasis on duration of illness suggests that this would be a productive area for educational efforts to reduce antibiotic prescribing for ARI in the emergency department.

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Antibiotic Treatment of Acute Respiratory Infections in Acute Care Settings

Abstract: Acute care settings are important targets for reducing inappropriate antibiotic prescribing. The mechanisms accounting for lower antibiotic prescription rates observed with housestaff-associated visits merit further study.

Cited by 44 publications

References 25 publications

Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice

Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice

Comparing VA and Non-VA Quality of Care: A Systematic Review

Factors Affecting Antibiotic Prescribing for Acute Respiratory Infection by Emergency Physicians

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