Impact of Implementing National Guidelines on Antibiotic Prescriptions for Acute Respiratory Tract Infections in Pediatric Emergency Departments: An Interrupted Time Series Analysis

Ouldali, Naïm; Bellêttre, Xavier; Milcent, Karen; Guedj, Romain; Pontual, Loïc de; Cojocaru, B; Soussan-Banini, Valérie; Craiu, Irina; Skurnik, David; Gajdos, Vincent; Chéron, G.; Cohen, Robert; Alberti, Corinne; Angoulvant, François

doi:10.1093/cid/cix590

Cited by 46 publications

(79 citation statements)

References 30 publications

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“…More than half of the children attending ED for an URTI received an antibiotic (56%), while international studies report a prevalence ranging from 5.1% in France to 37% in Guyana 12 13…”

Section: Discussionmentioning

confidence: 99%

“…Amoxicillin is the most commonly prescribed antibiotic in other countries. Looking at all URTIs, amoxicillin covered from 28% to 85% of antibiotic prescriptions in EDs 11–13 20. In children with AOM, amoxicillin was prescribed for 56% of the cases in the USA and 66% of the cases in France 7 17.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, upper respiratory tract infections (URTIs) are the most common reason for antibiotic prescriptions to children in both outpatient and ED settings 6–8. Antibiotic prescribing patterns to children attending ED do not appear to have been widely evaluated, and studies have mainly focused on a few countries and/or were on respiratory or urinary tract infections 6–21…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic prescription in the outpatient paediatric population attending emergency departments in Lombardy, Italy: a retrospective database review

Messina

Clavenna

Cartabia

et al. 2019

bmjpo

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ObjectivesThis study aimed to assess the appropriateness of antibiotic prescription in children seen in emergency departments (EDs) and to compare prescription profiles in ED and primary care.DesignThis is a retrospective analysis of healthcare administrative databases.SettingThe study analysed data collected in emergency departments (EDs) and primary care practices (PCPs) in Lombardy, Italy.ParticipantsChildren and adolescents between 1 and 13 years old with an ED access and/or an antibiotic prescription in the first semester of 2012 participated in the study. Only those with an index event (ie, without ED access, hospital admissions or antibiotic prescriptions in the previous 60 days) were included.Main outcome measuresThe main outcomes are percentage of subjects receiving amoxicillin (first-choice antibiotic) and percentages receiving macrolides/cephalosporins (second-choice therapies).ResultsDuring the observation period, 133 275 children had one ED access, and 26 087 (19.6%) received an antibiotic prescription. In all, 56.1% of children seen for upper respiratory tract infections (URTIs) received an antibiotic, with a prevalence of 67.8% for otitis media and 56.4% for pharyngotonsillitis; 22.3% of children were given amoxicillin after a visit for URTIs, with no differences among infections, and 19.6% received macrolides and cephalosporins. Few differences were found when comparing the index antibiotic prescriptions in ED and PCP settings. A higher prescription of second-choice antibiotics was observed among children cared for by PCPs compared with children attending EDs (31.3% vs 23.4%, χ2 M-H=720, p<0.001). The place of residence was the main determinant of the qualitative profile of prescriptions.ConclusionsMore must be done to improve rational use of antibiotics in the ED and PCP setting, and educational interventions including physicians in both setting are strongly needed.

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“…More than half of the children attending ED for an URTI received an antibiotic (56%), while international studies report a prevalence ranging from 5.1% in France to 37% in Guyana 12 13…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Antibiotic prescription in the outpatient paediatric population attending emergency departments in Lombardy, Italy: a retrospective database review

Messina

Clavenna

Cartabia

et al. 2019

bmjpo

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show abstract

“…antibiotic prescription for URTIs), involving not only general practitioners but also other subspecialists such as surgeons and gynecologists [66,67]. Greater efforts need to be made to motivate physicians to change their prescribing behaviors.…”

Section: Policy Implicationsmentioning

confidence: 99%

Knowledge, attitudes and intentions to prescribe antibiotics: a structural equation modeling study of primary care institutions in Hubei, China

Liu

Wang

et al. 2019

Preprint

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Background Antibiotic resistance is one of the most serious global issues, in which physician's rational prescribing plays critical role. However, the determinants of physician's antibiotic use are still inconclusive, particularly in low- and middle income countries (LMICs). This study aimed to measure physician's knowledge and five important sub-attitudes toward antibiotic prescriptions and their impacts on prescribing. Methods A questionnaire survey was conducted on 625 physicians from 67 primary care facilities in Hubei of China. Structural equation modelling (SEM) was applied to test the theoretical framework derived from the theory of Knowledge, Attitudes and Practices (KAP). The attitudes (5 subscales) and behavioral intentions (3 subscales) were measured using a five-point Likert scale ranging from -2 to +2, with a negative score indicating disapproval and a positive score indicating approval of efforts for reducing antibiotic prescriptions. Results The study participants had a low level of knowledge about antibiotic prescriptions, giving an average of 54.55% correct answers to 11 questions. Although they were generally concerned about antibiotic resistance resulting from over-prescriptions (Mean of Ignorance=1.28, SD=0.43), and were reluctant to be submissive to pressures from consumer demands for antibiotics (Mean of Complacency=1.29, SD=0.65) and the requirements of defensive practice (Mean of Fear=1.11, SD=0.63), there was a lack of motivation to change prescribing practices (Mean of Indifference=-0.29, SD=0.70). In addition, there was strong agreement that other stakeholders should take the responsibility (Mean of Responsibility Avoidance=-1.15, SD=0.45). The SEM results showed that poor knowledge was a significant predictor (p<0.001) of high intentions to prescribe antibiotics for upper respiratory tract infections and a less positive attitude toward concerns about antibiotic resistance (ignorance) which was also associated with intentions to prescribe antibiotics. However, knowledge was not connected with the negative attitude toward motivation (indifference), a significant predictor (p<0.001) of intentions to refuse to reduce antibiotic prescriptions. Conclusion Physicians in primary care facilities in Hubei have low levels of knowledge about antibiotic prescriptions. But actions for improving knowledge by itself is not enough to curb over-prescriptions of antibiotics. The lack of motivation of physicians to change prescribing practices needs to be addressed through a systems approach.

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“…Unnecessary antibiotic consumption in viral infections and antimicrobial resistance has prompted the implementation of antimicrobial stewardship programs (ASP). The ASPs including implementation of national guidelines (Ouldali et al, 2017) and pharmacist intervention (Davis et al, 2016;Santiago et al, 2016;Zhang et al, 2017) have been shown to decrease inappropriate antibiotic prescription in the ED. However, more clinical data are needed (Barlam et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of clinical pathway for upper respiratory tract infections in emergency department

Madran

Keske

Uzun

et al. 2019

International Journal of Infectious Diseases

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Objective: We aimed to demonstrate the benefits of implementing a clinical pathway to decrease the inappropriate use of antibiotics in upper respiratory tract infections (URTI) in an emergency department (ED). Methods: The study was performed in a hospital with 300 beds. All patients who applied with URTI from 1st to 30th of April 2017 were included and the appropriateness of the antibiotics were compared with the patients in the same period in 2016. A checklist for the clinical pathway of URTI was completed by the ED physicians. Results: 351 patients were included, 176 these patients were in pre-ASP period and 175 patients were in post-ASP period. The rate of prescriptions including antibiotics was 49% in pre-ASP period and has decreased to 29% in post-ASP period (p < 0.001). Adherence to clinical pathway has increased from 50% to 80% (p < 0.001). In the post-ASP period, clinical pathway was used in 133 out of 175 patients (76%) and the consequently rate of appropriate antibiotic use was 82%. Conclusion: The implementation of clinical pathway for URTI has decreased inappropriate antibiotic use in ED. As the secondary effect, using clinical pathway in ED also has increased the awareness of ED physicians who did not adhere to clinical pathway.

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Impact of Implementing National Guidelines on Antibiotic Prescriptions for Acute Respiratory Tract Infections in Pediatric Emergency Departments: An Interrupted Time Series Analysis

Abstract: Implementation of the 2011 national French guidelines led to a significant decrease in the antibiotic prescription rate for ARTI and a dramatic drop in broad-spectrum antibiotic prescriptions, in favor of amoxicillin.

Cited by 46 publications

References 30 publications

Antibiotic prescription in the outpatient paediatric population attending emergency departments in Lombardy, Italy: a retrospective database review

Antibiotic prescription in the outpatient paediatric population attending emergency departments in Lombardy, Italy: a retrospective database review

Knowledge, attitudes and intentions to prescribe antibiotics: a structural equation modeling study of primary care institutions in Hubei, China

Effectiveness of clinical pathway for upper respiratory tract infections in emergency department

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