Unnecessary Antibiotics for Acute Respiratory Tract Infections: Association With Care Setting and Patient Demographics

Barlam, Tamar F.; Soria-Saucedo, Rene; Cabral, Howard; Kazis, Lewis E.

doi:10.1093/ofid/ofw045

Cited by 51 publications

(48 citation statements)

References 32 publications

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“…All variable was considered potentially significant and further analyzed in a stepwise multivariate logistic regression model using the backward selection method for determining significant independent factors at P < 0.2. While these are a large number of variables to include, prior research demonstrates a variety of factors leading to overprescribing of broad spectrum antibiotics in cases of diagnostic uncertainty or clinical presentation, thus we felt it important to include demographic, clinical and test factors in our model [15, 16]. To reduce the number of variables included in the regression analyses, we collapsed urinary symptoms together (dysuria, frequent urination, and decreased urination) and non-urinary clinical symptoms together (back pain, abdominal pain, nausea/vomiting, and vaginal discharge).…”

Section: Methodsmentioning

confidence: 99%

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

et al. 2016

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BackgroundThe Emergency Department (ED) is a frequent site of antibiotic use; poor adherence with evidence-based guidelines and broad-spectrum antibiotic overuse is common. Our objective was to determine rates and predictors of inappropriate antimicrobial use in patients with uncomplicated urinary tract infections (UTI) compared to the 2010 International Clinical Practice Guidelines (ICPG).MethodsA single center, prospective, observational study of patients with uncomplicated UTI presenting to an urban ED between September 2012 and February 2014 that examined ED physician adherence to ICPG when treating uncomplicated UTIs. Clinician-directed antibiotic treatment was compared to the ICPG using a standardized case definition for non-adherence. Binomial confidence intervals and student’s t-tests were performed to evaluate differences in demographic characteristics and management between patients with pyelonephritis versus cystitis. Regression models were used to analyze the significance of various predictors to non-adherent treatment.Results103 cases met the inclusion and exclusion criteria, with 63.1 % receiving non-adherent treatment, most commonly use of a fluoroquinolone (FQ) in cases with cystitis (97.6 %). In cases with pyelonephritis, inappropriate antibiotic choice (39.1 %) and no initial IV antibiotic for pyelonephritis (39.1 %) where recommended were the most common characterizations of non-adherence. Overall, cases of cystitis were no more/less likely to receive non-adherent treatment than cases of pyelonephritis (OR 0.9, 95 % confidence interval 0.4–2.2, P = 0.90). In multivariable analysis, patients more likely to receive non-adherent treatment included those without a recent history of a UTI (OR 3.8, 95 % CI 1.3–11.4, P = 0.02) and cystitis cases with back or abdominal pain only (OR 11.4, 95 % CI 2.1–63.0, P = 0.01).ConclusionsPatients with cystitis with back or abdominal pain only were most likely to receive non-adherent treatment, potentially suggesting diagnostic inaccuracy. Physician education on evidence-based guidelines regarding the treatment of uncomplicated UTI will decrease broad-spectrum use and drug resistance in uropathogens.

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Section: Methodsmentioning

confidence: 99%

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

et al. 2016

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“…Acute respiratory tract infections (RTIs) are one of the leading causes of emergency department (ED) visits and are often due to viral pathogens [1][2][3][4]. Although viral infections are more common in children, studies based on national datasets show that the problem of antibiotic overuse in RTI is largest in adults [4][5][6]. Unfortunately, it is often not possible to differentiate between viral and bacterial diseases on clinical judgment alone [7].…”

Section: Introductionmentioning

confidence: 99%

“…As a gold standard to diagnose bacterial infections is missing, this study used an expert panel reference standard to diagnose each individual patient. Most studies that evaluated antibiotic misuse rates are based on national datasets and classify infections, using general codes, such as the International Classification of Diseases [4][5][6]. Using guidelines for assessing antibiotic misuse can result in contradictory analyses.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic misuse in respiratory tract infections in children and adults—a prospective, multicentre study (TAILORED Treatment)

Houten

Golan‐Cohen

Engelhard

et al. 2019

Eur J Clin Microbiol Infect Dis

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Respiratory tract infections (RTI) are more commonly caused by viral pathogens in children than in adults. Surprisingly, little is known about antibiotic use in children as compared to adults with RTI. This prospective study aimed to determine antibiotic misuse in children and adults with RTI, using an expert panel reference standard, in order to prioritise the target age population for antibiotic stewardship interventions. We recruited children and adults who presented at the emergency department or were hospitalised with clinical presentation of RTI in The Netherlands and Israel. A panel of three experienced physicians adjudicated a reference standard diagnosis (i.e. bacterial or viral infection) for all the patients using all available clinical and laboratory information, including a 28-day follow-up assessment. The cohort included 284 children and 232 adults with RTI (median age, 1.3 years and 64.5 years, respectively). The proportion of viral infections was larger in children than in adults (209(74%) versus 89(38%), p < 0.001). In case of viral RTI, antibiotics were prescribed (i.e. overuse) less frequently in children than in adults (77/209 (37%) versus 74/89 (83%), p < 0.001). One (1%) child and three (2%) adults with bacterial infection were not treated with antibiotics (i.e. underuse); all were mild cases. This international, prospective study confirms major antibiotic overuse in patients with RTI. Viral infection is more common in children, but antibiotic overuse is more frequent in adults with viral RTI. Together, these findings support the need for effective interventions to decrease antibiotic overuse in RTI patients of all ages. Electronic supplementary material The online version of this article (10.1007/s10096-018-03454-2) contains supplementary material, which is available to authorized users.

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“…Patients incorrectly perceive the antibiotic treatment for viral infections as effective, although the nature of viral disease is self‐limiting and would have resolved without the treatment . Also, the lack of awareness of AMR or lower college education could lead to more demand for antibiotics . An interventional study has shown that educating patients in AMR can change their expectation towards receiving antibiotics for an upper respiratory tract infection (URTI) …”

Section: Introductionmentioning

confidence: 99%

Patient expectation trends on receiving antibiotic prescriptions for respiratory tract infections: A systematic review and meta‐regression analysis

Kianmehr

Sabounchi

et al. 2019

Int J Clin Pract

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Background Despite a variety of programs developed to control inappropriate antibiotic prescribing for viral infections, antibiotics are still prescribed excessively for Respiratory Tract Infections (RTI). The patient’s expectation to receive an antibiotic often influences the clinician’s decision and can lead to inappropriate antibiotic prescriptions. Our objective was to investigate the changes in patient expectations over time when presenting with symptoms of a respiratory infection. Methods We performed a systematic review of patient’s expectation to receive antibiotics for RTIs. Two reviewers independently evaluated the collected studies based on inclusion and exclusion criteria. Our search initially identified 12 070 studies, of which 321 studies were eligible for full text review and 37 articles were selected for final evaluation. Meta‐regression analysis was used to evaluate the association between patient expectations and different years. Heterogeneity was evaluated using the Q statistic. Results Patient expectations (effect size) were pooled using a random effects model. The effect‐equality test showed heterogeneity among studies (Q = 3304.23, df = 40, P < 0.0001, k = 40, τ2 = 0.63). Meta‐regression results revealed that there is a significant linear negative relationship (B = −1.8374, P < 0.05) between patient expectation and year of data collection, at the global level. A similar finding is observed for the subset of studies conducted outside United States (U.S.) (B = −1.2411, P < 0.1). However, there is no discernible trend for patient expectation in the U.S. or among children and adult subgroups. Also, no significant differences are observed between the patient expectations when considering different age groups. Conclusion The trend of patient expectation for receiving antibiotics for RTIs is declining over time on a global level and also outside the U.S.

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Unnecessary Antibiotics for Acute Respiratory Tract Infections: Association With Care Setting and Patient Demographics

Cited by 51 publications

References 32 publications

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

Antibiotic misuse in respiratory tract infections in children and adults—a prospective, multicentre study (TAILORED Treatment)

Patient expectation trends on receiving antibiotic prescriptions for respiratory tract infections: A systematic review and meta‐regression analysis

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