Back-up antibiotic prescriptions could reduce unnecessary antibiotic use in rhinosinusitis

Martin, Corey L; Njike, Valentine Yanchou; Katz, David L.

doi:10.1016/j.jclinepi.2003.09.008

Cited by 10 publications

(7 citation statements)

References 30 publications

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“…Patient satisfaction varies with antibiotic prescription policies for ARTI and patients were less satisfied in practices with low antibiotic prescribing rates, and a cautious approach to antibiotic prescribing may require a trade-off in terms of patient satisfaction [ 41 , 65 ]. Patients were also less satisfied when they expected but were not prescribed antibiotics [ 48 , 66 , 67 ]. However, receiving information and reassurance from the HCP was also associated with high patient satisfaction (Table 3 ) [ 64 , 68 ].…”

Section: Resultsmentioning

confidence: 99%

“…The PCP usually negotiates with the patient that they are not to be used immediately but only if the patient feels that their symptoms deteriorate or do not improve as expected [ 93 ]. There is substantial evidence that the use of delayed prescriptions has been associated with reduced antibiotic use [ 48 , 100 – 108 ]. The DESCARTE study has been looking at the symptomatic outcome of acute sore throat in a random sample of 2876 adults according to antibiotic prescription strategy in routine care.…”

Section: Resultsmentioning

confidence: 99%

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Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review

et al. 2018

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BackgroundAntimicrobial resistance is an emerging global threat to health and is associated with increased consumption of antibiotics. Seventy-four per cent of antibiotic prescribing takes place in primary care. Much of this is for inappropriate treatment of acute respiratory tract infections.AimsTo review the published literature pertaining to antibiotic prescribing in order to identify and understand the factors that affect primary care providers’ prescribing decisions.MethodsSix online databases were searched for relevant paper using agreed criteria. One hundred ninety-five papers were retrieved, and 139 were included in this review.ResultsPrimary care providers are highly influenced to prescribe by patient expectation for antibiotics, clinical uncertainty and workload induced time pressures. Strategies proven to reduce such inappropriate prescribing include appropriately aimed multifaceted educational interventions for primary care providers, mass media educational campaigns aimed at healthcare professionals and the public, use of good communication skills in the consultation, use of delayed prescriptions especially when accompanied by written information, point of care testing and, probably, longer less pressurised consultations. Delayed prescriptions also facilitate focused personalised patient education.ConclusionThere is an emerging consensus in the literature regarding strategies proven to reduce antibiotic consumption for acute respiratory tract infections. The widespread adoption of these strategies in primary care is imperative.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review

et al. 2018

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“…The aforementioned feeling among GPs was that, because the consultation allows the GP to form an evidence-based opinion as to the non-bacterial nature of the disease, their role is in educating the patient and non-antibiotic treatment of symptoms such as pain and fever. It is true that patient satisfaction varies with antibiotic prescription policies for ARTI and patients are less satisfied in practices with low antibiotic prescribing rates [38] or when they expect but are not prescribed antibiotics [42, 43]. A strategy of delayed prescriptions was commonly employed by interviewees.…”

Section: Discussionmentioning

confidence: 99%

Over prescribing of antibiotics for acute respiratory tract infections; a qualitative study to explore Irish general practitioners’ perspectives

et al. 2019

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Background Anti-microbial resistance (AMR) is a global threat to public health and antibiotics are often unnecessarily prescribed for acute respiratory tract infections (ARTIs) in general practice. We aimed to investigate why general practitioners (GPs) continue to prescribe antibiotics for ARTIs despite increasing knowledge of their poor efficacy and worsening antimicrobial resistance. Methods We used an explorative qualitative study design. Thirteen GPs were recruited through purposive sampling to represent urban and rural settings and years of experience. They were based in general practices within the Mid-West of Ireland. GPs took part in semi-structured interviews that were digitally audio recorded and transcribed. Results Three main themes and three subthemes were identified. Themes include (1) non-comprehensive guidelines; how guideline adherence can be difficult, (2) GPs under pressure; pressures to prescribe from patients and perceived patient expectations and (3) Unnecessary prescribing; how to address it and the potential of public interventions to reduce it. Conclusions GPs acknowledge their failure to implement guidelines because they feel they are less usable in clinical situations. GPs felt pressurised to prescribe, especially for fee-paying patients and in out of hours settings (OOH), suggesting the need for interventions that target the public’s perceptions of antibiotics. GPs behaviours surrounding prescribing antibiotics need to change in order to reduce AMR and change patients’ expectations. Electronic supplementary material The online version of this article (10.1186/s12875-019-0917-8) contains supplementary material, which is available to authorized users.

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“…11, 12, 21 Yet, antibiotic treatment for upper respiratory infections is often both expected by patients and prescribed by doctors. 14, 27 Indeed, patient's expectation that antibiotic treatment is needed to resolve sinus symptoms may explain their reluctance to participate in this randomized trial where antibiotic treatment was not assured, but we do not have data to confirm this. The NICE guidelines in the UK, and more recent guidelines in the U.S. suggest an alternative approach to management for patients for whom reassessment is possible that delays and may preclude antibiotic treatment: watchful waiting with symptomatic treatments and an explanation of the natural history of the disease.…”

Section: Commentmentioning

confidence: 96%

“…The NICE guidelines in the UK, and more recent guidelines in the U.S. suggest an alternative approach to management for patients for whom reassessment is possible that delays and may preclude antibiotic treatment: watchful waiting with symptomatic treatments and an explanation of the natural history of the disease. 15, 20 Delayed antibiotic prescriptions, a strategy more commonly used in Europe than the U.S., 27 was effective in a study from the Netherlands. 28 Analgesics are recommended, but additional therapies to provide symptom relief and a feasible alternative to antibiotic treatment are needed.…”

Section: Commentmentioning

confidence: 99%

Amoxicillin for Acute Rhinosinusitis

Garbutt¹,

Banister²,

Spitznagel³

et al. 2012

JAMA

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Context Evidence to support antibiotic treatment for acute rhinosinusitis is scant, yet antibiotics are commonly used. Objective To determine the incremental effect of amoxicillin treatment over symptomatic treatments for adults with clinically diagnosed acute rhinosinusitis. Design Randomized placebo-controlled trial Participants and Setting Adults with uncomplicated, acute rhinosinusitis were recruited from 10 community practices in Missouri between November 1st 2006 and May 1st 2009 Interventions Ten-day course of either amoxicillin (1500mg/day) or placebo administered in three doses/day. All patients received a 5-7-day supply of symptomatic treatments for pain, fever, cough and nasal congestion to use as needed. Main Outcome Measures The primary outcome was improvement in the disease-specific quality of life after 3–4 days of treatment assessed with the SNOT-16 (minimally important difference 0.5 on 0 to 3 scale). Secondary outcomes included the patients' retrospective assessment of change in sinus symptoms and functional status, recurrence or relapse, satisfaction with and adverse effects of treatment. Outcomes were assessed by telephone interview at Days 3, 7, 10 and 28. Results 166 adults (36% male, 78% Caucasian) were randomized to amoxicillin (85) or placebo (81); 92% concurrently used ≥1 symptomatic treatment (amoxicillin, 94%, placebo 90%, p=0.34). The mean change in SNOT-16 scores was not significantly different between groups on Day 3 (mean difference between groups 0.03, 95% CI −0.12 to 0.19) and Day 10, but differed at Day 7 favoring amoxicillin (mean difference between groups 0.19, 95% CI 0.024 to 0.35). At Day 7 more participants treated with amoxicillin reported symptom improvement (74% vs. 56%, p=0.0205; NNT = 6, 95% CI 3 to 34), with no difference at Day-3 or Day-10. No between group differences were found for any other secondary outcomes. No serious adverse events occurred. Conclusion Among patients with acute rhinosinusitis, a 10-day course of amoxicillin compared with placebo did not reduce symptoms at day 3 of treatment.

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Back-up antibiotic prescriptions could reduce unnecessary antibiotic use in rhinosinusitis

Cited by 10 publications

References 30 publications

Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review

Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review

Over prescribing of antibiotics for acute respiratory tract infections; a qualitative study to explore Irish general practitioners’ perspectives

Amoxicillin for Acute Rhinosinusitis

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