Systematic Review on the Impact of Guidelines Adherence on Antibiotic Prescription in Respiratory Infections

Abstract

Overuse and inappropriate antibiotic prescription for respiratory tract infections (RTI) are one of the major contributors to the current antibiotic resistance problem. Guidelines provide support to prescribers for proper decision-making. Our purpose is to review the impact of prescribers’ exposure to guidelines in antibiotic prescription for RTIs. A systematic review was performed searching in the scientific databases MEDLINE PubMed and EMBASE for studies which exposed prescribers to guidelines for RTI and compared antibiotic prescription rates/quality before and after the implementation, with thirty-four articles included in the review. The selected studies consisted on a simple intervention in the form of guideline implementation while others involved multifaceted interventions, and varied in population, designs, and settings. Prescription rate was shown to be reduced in the majority of the studies, along with an improvement in appropriateness, defined mainly by the prescription of narrow-spectrum rather than broad-spectrum antibiotics. Intending to ascertain if this implementation could decrease prescription costs, 7 articles accessed it, of which 6 showed the intended reduction. Overall interventions to improve guidelines adherence can be effective in reducing antibiotic prescriptions and inappropriate antibiotic selection for RTIs, supporting the importance of implementing guidelines in order to decrease the high levels of antibiotic prescriptions, and consequently reduce antimicrobial resistance.

Exploring Information Available to and Used by Physicians on Antibiotic Use and Antibiotic Resistance in Jordan

“…Our results showed that the practitioners relied mostly on published guidelines for antibiotic prescribing, which is among the most important strategies to enhance prudent antibiotic prescribing behavior [ 49 , 50 , 51 ]. Generally, the implementation of guidelines and antimicrobial stewardship initiatives to direct prudent antibiotic prescribing are key elements in enhancing the appropriate use of antibiotics [ 41 , 44 , 49 , 52 , 53 , 54 ].…”

Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis

“…A potentially discerning aspect in the need for IMV in critical bronchiolitis may arise from complicating bacterial pneumonias. The AAP discourages the routine use of antibiotics in this population unless there is a clear source of bacterial infection [8,36]. In intubated critical bronchiolitis patients, despite practice variations across the country, early antibiotic initiation was associated with shorter duration of mechanical ventilation and shorter hospitalizations [37].…”

Prescribing antibiotics in adults with respiratory tract infections in Lebanon

“…Most RTIs are self-limited with a marginal effect for antimicrobial treatment to prevent complications. 20 Evidence indicates that antimicrobial treatment of these conditions exacerbates antimicrobial resistance amongst common bacterial strains whilst providing patients with little benefit. [21][22][23][24] It also increases healthcare costs, puts patients at risk of drug reactions and allergies and predisposes them to other complications such as Clostridium difficile infections.…”

“…Implementing and improving adherence to clinical guidelines were found to be effective in reducing prescription and the inappropriate selection of antibiotics for RTIs. 20 At a national level, it is necessary to promote antibiotic agents' optimal use by improving knowledge and setting implementation strategies that control their use. Multifaceted interventions should target capacity building of practitioners especially primary care physicians on the rational use of antibiotics, developing national clinical guidelines for the management of RTIs and other conditions with common misuse of antibiotics, increasing public awareness of antimicrobial resistance, strengthening surveillance and investing in research whilst engaging policymakers, healthcare practitioners and the public.…”