scholarly journals Retrospective review of the management of acute infections and the indications for antibiotic prescription in primary care in northern Thailand

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e022250 ◽  
Author(s):  
Rachel C Greer ◽  
Daranee Intralawan ◽  
Mavuto Mukaka ◽  
Prapass Wannapinij ◽  
Nicholas P J Day ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Retrospective Review ◽  
Antibiotic Prescription ◽  
Multivariable Logistic Regression Analysis ◽  
Upper Respiratory Tract ◽  
Acute Tonsillitis ◽  
Northern Thailand ◽  
Acute Infections ◽  
Tract Infections

IntroductionAntibiotic use in low-income and middle-income countries continues to rise despite the knowledge that antibiotic overuse can lead to antimicrobial resistance. There is a paucity of detailed data on the use of antibiotics in primary care in low-resource settings.ObjectiveTo describe the presentation of acute infections and the indications for antibiotic prescription.DesignA 2-year retrospective review of routinely collected data.SettingAll 32 primary care units in one district in northern Thailand.ParticipantsPatients attending primary care with a history of fever, documented temperature, International Statistical Classification of Diseases 10 code for infection or prescribed a systemic antibiotic. Patients attending after the initiation of a study on C-reactive protein testing in four centres were excluded.Outcome measuresThe proportion of patients prescribed an antibiotic and the frequency of clinical presentations.Results762 868 patients attended the health centres, of whom 103 196 met the inclusion criteria, 5966 were excluded resulting in 97 230 attendances consisting of 83 661 illness episodes.46.9% (39 242) of the patients were prescribed an antibiotic during their illness. Indications for antibiotic prescription in the multivariable logistic regression analysis included male sex (adjusted OR (aOR) 1.21 (95% CI 1.16 to 1.28), p<0.001), adults (aOR 1.77 (95% CI 1.57 to 2), p<0.001) and a temperature >37.5°C (aOR 1.24 (95% CI 1.03 to 1.48), p=0.020). 77.9% of the presentations were for respiratory-related problems, of which 98.6% were upper respiratory tract infections. The leading infection diagnoses were common cold (50%), acute pharyngitis (18.9%) and acute tonsillitis (5%) which were prescribed antibiotics in 10.5%, 88.7% and 87.1% of cases, respectively. Amoxicillin was the most commonly prescribed antibiotic.ConclusionsNearly half of the patients received an antibiotic, the majority of whom had a respiratory infection. The results can be used to plan interventions to improve the rational use of antibiotics. Further studies in private facilities, pharmacies and dental clinics are required.

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

2019 ◽  
Vol 3 (1) ◽  
pp. e000546 ◽  
Author(s):  
Francesco Messina ◽  
Antonio Clavenna ◽  
Massimo Cartabia ◽  
Daniele Piovani ◽  
Angela Bortolotti ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Hospital Admissions ◽  
Antibiotic Prescription ◽  
Educational Interventions ◽  
Paediatric Population ◽  
Administrative Databases ◽  
Upper Respiratory Tract ◽  
First Choice ◽  
Tract Infections

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%, χ2M-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.

scholarly journals Delayed antibiotic prescription in upper respiratory tract infections: a new trend?

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Carolina Castanheira ◽  
Isabel Andrade ◽  
Rui Cruz
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescription ◽  
Upper Respiratory Tract Infections ◽  
Upper Respiratory Tract ◽  
Rapid Tests ◽  
Upper Respiratory ◽  
Tract Infections ◽  
Delayed Antibiotic Prescription

Abstract Background Upper respiratory tract infections (URTI) are one of the main reasons for consultation in primary care. Approximately 60% of all antibiotic prescriptions aim at the treatment of URTI, even without a laboratory-based diagnosis. Delayed antibiotic prescription in primary care has shown to reduce antibiotic consumption, without increasing risk of complications, yet is not widely used. Rapid tests to confirm the etiology of URTI are available at pharmacies, but not purchased routinely. In this context, the aim of this study is to assess the knowledge of rapid tests for the diagnosis of URTI, and the awareness of strategies to decrease antibiotic use. Methods A team of experts in the field developed a questionnaire specifically for the purpose of this study. The Pharmacy graduate students of ESTESC-Coimbra Health School (Portugal) answered the questionnaire online. Results Over 90% of the respondents with a URTI stated that the general practitioner prescribed the antibiotic without a lab test. When given the option, 58% are willing to pay up to 50 Euros for a rapid test, yet are not familiar with any brand. Although the respondents aren’t familiarized with the concept, when asked, the majority (87%) are more likely to choose a delayed than an immediate prescription. Conclusions Pharmacy graduates are willing to support the use of delayed prescription, to give time for the lab confirmation of the diagnosis. A broader dissemination of the clinical evidence supporting the use of rapid tests and of delayed prescription is necessary to help managing URTI.

scholarly journals Does diagnostic uncertainty increase antibiotic prescribing in primary care?

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Dan Wang ◽  
Chaojie Liu ◽  
Xinping Zhang ◽  
Chenxi Liu
Keyword(s):  
Primary Care ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Acute Tonsillitis ◽  
Diagnostic Uncertainty ◽  
Patient Tolerance ◽  
Prescribing Behaviour ◽  
Tolerance Of Uncertainty ◽  
Tract Infections

AbstractThis study aimed to determine the association between factors relevant to diagnostic uncertainty and physicians’ antibiotic-prescribing behaviour in primary care. A questionnaire survey was conducted on 327 physicians that measured their diagnostic ability, perceived frequency of diagnostic uncertainty, tolerance, and perceived patient tolerance of uncertainty. Physician antibiotic-prescribing behaviours were assessed based on their prescriptions (n = 207,804) of three conditions: upper respiratory tract infections (URTIs, antibiotics not recommended), acute tonsillitis (cautious use of antibiotics), and pneumonia (antibiotics recommended). A two-level logistic regression model determined the association between diagnostic uncertainty factors and physician antibiotic prescribing. Physicians perceived a higher frequency of diagnostic uncertainty resulting in higher antibiotic use for URTIs and less antibiotic use for pneumonia. Higher antibiotic use for acute tonsillitis was related to a low tolerance of uncertainty of physicians and patients. This study suggests that reducing diagnostic uncertainty and improving physician and patient uncertainty management could reduce antibiotic use.

scholarly journals Inappropriate Azithromycin Use in Nine Primary-Care Clinics Before and After Implementation of Provider Guidance in the EMR

2020 ◽  
Vol 41 (S1) ◽  
pp. s292-s293
Author(s):  
Alexandria May ◽  
Allison Hester ◽  
Kristi Quairoli ◽  
Sheetal Kandiah
Keyword(s):  
Primary Care ◽  
Retrospective Chart Review ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
National Guidelines ◽  
Targeted Interventions ◽  
Primary Care Clinics ◽  
Before And After ◽  
Upper Respiratory ◽  
Tract Infections

Background: According to the CDC Core Elements of Outpatient Stewardship, the first step in optimizing outpatient antibiotic use the identification of high-priority conditions in which antibiotics are commonly used inappropriately. Azithromycin is a broad-spectrum antimicrobial commonly used inappropriately in clinical practice for nonspecific upper respiratory infections (URIs). In 2017, a medication use evaluation at Grady Health System (GHS) revealed that 81.4% of outpatient azithromycin prescriptions were inappropriate. In an attempt to optimize outpatient azithromycin prescribing at GHS, a tool was designed to direct the prescriber toward evidence-based therapy; it was implemented in the electronic medical record (EMR) in January 2019. Objective: We evaluated the effect of this tool on the rate of inappropriate azithromycin prescribing, with the goal of identifying where interventions to improve prescribing are most needed and to measure progress. Methods: This retrospective chart review of adult patients prescribed oral azithromycin was conducted in 9 primary care clinics at GHS between February 1, 2019, and April 30, 2019, to compare data with that already collected over a 6-month period in 2017 before implementation of the antibiotic prescribing guidance tool. The primary outcome of this study was the change in the rate of inappropriate azithromycin prescribing before and after guidance tool implementation. Appropriateness was based on GHS internal guidelines and national guidelines. Inappropriate prescriptions were classified as inappropriate indication, unnecessary prescription, excessive or insufficient treatment duration, and/or incorrect drug. Results: Of the 560 azithromycin prescriptions identified during the study period, 263 prescriptions were included in the analysis. Overall, 181 (68.8%) of azithromycin prescriptions were considered inappropriate, representing a 12.4% reduction in the primary composite outcome of inappropriate azithromycin prescriptions. Bronchitis and unspecified upper respiratory tract infections (URI) were the most common indications where azithromycin was considered inappropriate. Attending physicians prescribed more inappropriate azithromycin prescriptions (78.1%) than resident physicians (37.0%) or midlevel providers (37.0%). Also, 76% of azithromycin prescriptions from nonacademic clinics were considered inappropriate, compared with 46% from academic clinics. Conclusions: Implementation of a provider guidance tool in the EMR lead to a reduction in the percentage of inappropriate outpatient azithromycin prescriptions. Future targeted interventions and stewardship initiatives are needed to achieve the stewardship program’s goal of reducing inappropriate outpatient azithromycin prescriptions by 20% by 1 year after implementation.Funding: NoneDisclosures: None

scholarly journals Antibiotic exposure and ‘response failure’ for subsequent respiratory tract infections: an observational cohort study of UK preschool children in primary care

2019 ◽  
Vol 69 (686) ◽  
pp. e638-e646 ◽  
Author(s):  
Oliver van Hecke ◽  
Alice Fuller ◽  
Clare Bankhead ◽  
Sara Jenkins-Jones ◽  
Nick Francis ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Preschool Children ◽  
Respiratory Tract ◽  
Treatment Failure ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescription ◽  
Antibiotic Exposure ◽  
Tract Infections ◽  
Antibiotic Courses

BackgroundChildhood antibiotic exposure has important clinically relevant implications. These include disruption to the microbiome, antibiotic resistance, and clinical workload manifesting as treatment ‘failure’.AimTo examine the relationship between the number of antibiotic courses prescribed to preschool children for acute respiratory tract infections (RTI), in the preceding year, and subsequent RTIs that failed to respond to antibiotic treatment (‘response failures’).Design and settingA cohort study using UK primary care data from the Clinical Practice Research Datalink, 2009 to 2016.MethodChildren aged 12 to 60 months (1 to 5 years) who were prescribed an antibiotic for an acute RTI (upper and lower RTI or otitis media) were included. One random index antibiotic course for RTI per child was selected. Exposure was the number of antibiotic prescriptions for acute RTI up to 12 months before the index antibiotic prescription. The outcome was ‘response failure’ up to 14 days after index antibiotic prescription, defined as: subsequent antibiotic prescription; referral; hospital admission; death; or emergency department attendance within 3 days. The authors used logistic regression models to estimate the odds between antibiotic exposure and response failure.ResultsOut of 114 329 children who were prescribed an antibiotic course for acute RTI, children who received ≥2 antibiotic courses for acute RTIs in the preceding year had greater odds of response failure; one antibiotic course: adjusted odds ratio (OR) 1.03 (95% confidence interval [CI] = 0.88 to 1.21), P = 0.67, n = 230 children; ≥2 antibiotic courses: adjusted OR 1.32 (CI = 1.04 to 1.66), P = 0.02, n = 97.ConclusionChildhood antibiotic exposure for acute RTI may be a good predictor for subsequent response failure (but not necessarily because of antibiotic treatment failure). Further research is needed to improve understanding of the mechanisms underlying response failure.

scholarly journals Antibiotic prescribing quality for children in primary care: an observational study

2018 ◽  
Vol 68 (667) ◽  
pp. e90-e96 ◽  
Author(s):  
Megan Rose Williams ◽  
Giles Greene ◽  
Gurudutt Naik ◽  
Kathryn Hughes ◽  
Christopher C Butler ◽  
...  
Keyword(s):  
Primary Care ◽  
Young Children ◽  
Otitis Media ◽  
Descriptive Analysis ◽  
Inappropriate Prescribing ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Tract Infections ◽  
Disease Specific

BackgroundOveruse and inappropriate prescribing of antibiotics is driving antibiotic resistance. GPs often prescribe antibiotics for upper respiratory tract infections (URTIs) in young children despite their marginal beneficial effects.AimTo assess the quality of antibiotic prescribing for common infections in young children attending primary care and to investigate influencing factors.Design and settingAn observational, descriptive analysis, including children attending primary care sites in England and Wales.MethodThe Diagnosis of Urinary Tract infection in Young children study collected data on 7163 children aged <5 years, presenting to UK primary care with an acute illness (<28 days). Data were compared with the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) disease-specific quality indicators to assess prescribing for URTIs, tonsillitis, and otitis media, against ESAC-Net proposed standards. Non-parametric trend tests and χ2tests assessed trends and differences in prescribing by level of deprivation, site type, and demographics.ResultsPrescribing rates fell within the recommendations for URTIs but exceeded the recommended limits for tonsillitis and otitis media. The proportion of children receiving the recommended antibiotic was below standards for URTIs and tonsillitis, but within the recommended limits for otitis media. Prescribing rates increased as the level of deprivation decreased for all infections (P<0.05), and increased as the age of the child increased for URTIs and tonsillitis (P<0.05). There were no other significant trends or differences.ConclusionThe quality of antibiotic prescribing in this study was mixed and highlights the scope for future improvements. There is a need to assess further the quality of disease-specific antibiotic prescribing in UK primary care settings using data representative of routine clinical practice.

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