Systematic review of determinants influencing antibiotic prescribing for uncomplicated acute respiratory tract infections in adult patients at the emergency department

Abstract

Objective: Overuse of antibiotics in the emergency department (ED) for uncomplicated acute respiratory tract infections (uARTIs) is a public health issue that needs to be addressed. We aimed to identify factors associated with antibiotic use for uARTIs in adults presenting at the ED. Design: We searched Medline, Embase, PsycINFO and the Cochrane Library for articles published from 1 January 2005 to 30 June 2017 using a predetermined search strategy. Titles and abstracts of English articles on antibiotic prescription and inappropriate antibiotic use for adult ARTI at EDs were assessed, followed by full article review, by 2 authors. Setting: Emergency departments. Participants: Adults aged 18 years and older. Results: Of the 2,591 articles retrieved, 12 articles met the inclusion criteria and 11 studies were conducted in the United States. Patients with normal C-reactive protein levels and positive influenza tests were less likely to receive antibiotic treatment. Nonclinical factors associated with antibiotic use were longer waiting time and perceived patient desire for antibiotics. Patients attended by internal medicine physicians comanaged by house staff or who visited an ED which provided education to healthcare providers on antibiotics use were less likely to receive antibiotics. Conclusions: English-language articles that fulfilled the selection criteria outside the United States were limited. Factors associated with antibiotics use are multifaceted. Education of healthcare providers presents an opportunity to improve antibiotic use.

A multi-institutional exploration of emergency medicine physicians’ attitudes and behaviours on antibiotic use during the COVID-19 pandemic: a mixed-methods study

“…Uncomplicated URTI visits to the EDs are often unnecessary as they can be easily managed in the primary care setting. Factors influencing antibiotic prescribing in the ED include perceived patient expectations for antibiotics, diagnostic uncertainties, socio-demographic factors of the patient, time pressure faced in the ED, influence from colleagues, and personal experience in practicing medicine [ 13 – 15 ].…”

Use of infection biomarkers in the emergency department

“…The effect of CRP on antibiotic initiation and antibiotic treatment processes is evaluated, and normal CRP values generally reduce the frequency of antibiotic prescribing in emergency departments. [ 48 ] This effect is generally present in patients with upper-lower respiratory tract infections and fever in primary health-care delivery. In patients with fever, CRP values of <40 mg/L decreased the frequency of antibiotic prescribing, without changing clinical outcomes, compared with the control group (39% vs. 34%, aOR: 0.80, 95% CI: 0.65–0.98).…”

Assessing the methodological quality of studies included in systematic reviews: Interpretation of scores

“…The fourth option does not allow for selection or stratification of studies based on quality scores. In systematic reviews recently published in the journal Infection Control and Hospital Epidemiology, assessment of risk of bias was either not reported, 3,4 an interpretation was not given and scores were reported for each individual study, 5 and/or the threshold was chosen by the authors. 6,7 We feel that scores alone do not give enough guidance to properly estimate the quality of a study.…”