Evidence-based strategies for better antibiotic prescribing

Magin, Parker; Davey, Andrew; Davis, Joshua S.

doi:10.31128/ajgp-07-21-6089

Cited by 8 publications

(4 citation statements)

References 35 publications

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“…We estimated (1) the annual number of antibiotic prescriptions per 1,000 individuals, overall, by region, and by metropolitan statistical area (MSA) and (2) the degree to which outpatient visit rates per 1,000 individuals and per-visit prescribing rates each explain geographic variation in antibiotic prescription rates.…”

Section: Methodsmentioning

confidence: 99%

“…Reducing antibiotic consumption is a major public health objective. Various interventions have been deployed to ensure that physicians only prescribe antibiotics for appropriate conditions (1,2), yet there remains substantial antibiotic use (3,4). Reducing antibiotic consumption may require looking beyond clinical decisions about a patient’s need for antibiotics to the upstream factors that influence the rates of medical encounters that lead to antibiotic prescriptions, such as the prevalence of infectious diseases and access to care.…”

Section: Introductionmentioning

confidence: 99%

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Drivers of geographic patterns in outpatient antibiotic prescribing in the United States

Kissler,

Roster,

Petherbridge

et al. 2023

Preprint

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Receipt of antibiotics per capita vary dramatically across regions in the United States, but the relative importance in prescribing practices versus per capita visit rates in driving this variation remain unclear. Quantifying their relative importance can aid in reducing antibiotic use. Using US medical claims data from 2015-2018 covering over 15 million privately insured adults, we conducted a regression analysis to estimate the relative contribution of outpatient visit rates and per-visit prescribing in explaining variation in outpatient antibiotic prescribing rates across metropolitan statistical areas. Variation in visit rates per capita explained more of the geographic variation in outpatient antibiotic prescribing rates than per-visit prescribing for conditions with high prescribing volume. Efforts to reduce antibiotic use may benefit from addressing the factors driving higher rates of outpatient visits, in addition to continued focus on stewardship.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Drivers of geographic patterns in outpatient antibiotic prescribing in the United States

Kissler,

Roster,

Petherbridge

et al. 2023

Preprint

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“…Clinical criteria for initiating empiric antimicrobial therapy were recommended in a consensus guideline (40). (41).…”

Section: Management Of Utimentioning

confidence: 99%

Urinary Tract Infections Among Geriatric Patients: A Systematic Review

Alamri¹,

Alnamlah²,

Altulayqi³

et al. 2022

JOHS

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Urinary tract infection (UTI) is the second most popular infection in the geriatric community, and the first popular is urine and fecal incontinence. Because of the effects of immunological aging, elderly are more susceptible to bacterial microorganisms and viral infections. The disease ranges from relatively harmless cystitis to potentially fatal pyelonephritis. This article aims to discuss the epidemiology, diagnosis, risk factors, progress of the disease, causative microorganisms, and guidelines for drug management of UTIs in geriatric patients. This study was performed following the PRISMA checklist. PubMed (2016-2022), Biological Sciences (ProQuest) (2012-2022), and ScienceDirect were used to locate English-language literature (2018-2022). We extracted data to assess the epidemiology, diagnosis, risk factors, causative microorganisms, and treatment management of UTIs in geriatric patients. This systematic review encompassed 11 observational studies including a total of 945,908 elderly patients and were published between 2012 and 2022. The prevalence varies across the studies. Urinary catheterization, gender, polypharmacy, comorbidities especially diabetes mellites older age, dementia, older age, vaginitis, previous history of UTI, bedridden state, and antimicrobial use were the independent risk factors. E. coli was the most found causative agent. Antibiotics were given specifically for UTIs. Despite the high rate of risk factors and prevalence of UTIs in the geriatric, treatment options are minimal. There is no evidence to support the use of antibiotics for long-term UTI prevention. However, alternative prophylaxis methods for patients with recurring infections must be developed. Although further studies are required to properly understand the clinical features and treatment modalities in elderly patients within the community or under institutional care.

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“… 1 Several factors contribute to continuation of unnecessary antimicrobials in the inpatient setting. These include patient-level factors such as frailty and comorbidities 1 , prescriber-level factors such as diagnostic uncertainty 2 and fear of adverse clinical outcomes 3 , as well as institution-level factors such as prescribing culture 4 and hierarchy in clinical decision-making. 5 Delayed prescribing initiatives, while successful in reducing inappropriate antibiotic use in the ambulatory setting 4 , have limited applicability in the fast-paced inpatient setting.…”

Section: Introductionmentioning

confidence: 99%

Reaching high-hanging fruit in antimicrobial stewardship: a hospital-based intervention to withdraw inappropriately prescribed antimicrobials

Khan,

Krichavets,

Feldmesser

2024

ASHE

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Background: Antimicrobial stewardship programs (ASPs) are responsible for addressing unnecessary antimicrobial use. We describe our experience with a unique intervention to withdraw unnecessary antimicrobials. Methods: Design, Setting, Participants: descriptive case series of adult inpatients at a single academic medical center, December 2021 to December 2022; Intervention: hospital-wide policy allowing ASP to discontinue inappropriate antimicrobials in select cases not resolved by prospective audit and feedback; Measures: count, date, and generic names of antimicrobials prescribed; reason for antimicrobial withdrawal (prolonged duration, no evidence of infection, or other); withdrawals by inpatient service (surgical or medical); time from antimicrobial start date to withdrawal intervention; days of therapy (DOT) saved; “nudge effect” defined as the prescribing team self-discontinuing withdrawn antimicrobial within 24 hours of withdrawal notice; appeals to withdrawals; ordering of alternative antimicrobials following withdrawal; incident infections, readmission, in-hospital mortality within 30 days of withdrawal intervention. Results: There were 54 antimicrobials withdrawn among 36 unique patients during the study period; piperacillin-tazobactam followed by vancomycin were the most frequently withdrawn agents; prolonged duration of therapy or prophylaxis followed by no evidence of infection were the most common reasons for withdrawal; withdrawals occurred most often on surgical services; an estimated 236 DOT (27.2 DOT per 100 patient-days) were saved; 32% of withdrawals were appealed; alternative antimicrobials were ordered following 20% of withdrawals; no incident infections, readmissions or in-hospital deaths were definitively attributed to withdrawal intervention. Conclusions: Our antimicrobial withdrawal intervention was a safe and effective addition to ASP activities to reduce inappropriate antimicrobial use and improve prescriber accountability.

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Evidence-based strategies for better antibiotic prescribing

Abstract: BackgroundAntibiotic resistance is a key global health threat, and antibiotic overuse is a significant contributing factor. Antibiotic stewardship is a vital issue for general practice.

Cited by 8 publications

References 35 publications

Drivers of geographic patterns in outpatient antibiotic prescribing in the United States

Drivers of geographic patterns in outpatient antibiotic prescribing in the United States

Urinary Tract Infections Among Geriatric Patients: A Systematic Review

Reaching high-hanging fruit in antimicrobial stewardship: a hospital-based intervention to withdraw inappropriately prescribed antimicrobials

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