Pharmacy-Based Intervention to Reduce Antibiotic Use for Acute Bronchitis

2003 ◽  
Vol 37 (2) ◽  
pp. 187-191 ◽  
Author(s):  
David E Hickman ◽  
Marilyn R Stebbins ◽  
John R Hanak ◽  
B Joseph Guglielmo
Keyword(s):  
Intervention Program ◽  
Acute Bronchitis ◽  
Antibiotic Use ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Group Model ◽  
Community Based ◽  
Health Maintenance ◽  
Physician Group ◽  
The Impact

BACKGROUND: Intervention programs can reduce inappropriate antibiotic use for the treatment of acute bronchitis in a closed health maintenance organization model. OBJECTIVE: To evaluate the impact of a pharmacy-based intervention program intended to reduce antibiotic use in the treatment of acute bronchitis in a community-based physician group model. SUBJECTS: Adult and pediatric patients with an office or urgent care visit for acute bronchitis during the baseline and study periods were included in the study. The clinicians were primary care physicians, nurse practitioners, and physician assistants in a suburban community-based physician group setting. METHODS: All patients treated for acute bronchitis from January 1 through June 30, 1998, were evaluated for initial receipt of antibiotics and use of clinic resources (office visits, additional antibiotics). From September through December of 1998, physicians were provided literature from the Centers for Disease Control and Prevention (CDC), cough and cold package inserts, and newsletters intended to educate the providers regarding the inappropriateness of antibiotics in the treatment of acute bronchitis. Patient-directed literature from the CDC was placed in the examination rooms and clinic waiting areas beginning September 1998. From January 1 through June 30, 1999, all patients treated for acute bronchitis were assessed for receipt of antibiotics and use of clinic resources. A separate geographic clinic site served as a control during both study periods. RESULTS: During 1998, 888 of 1840 patients (48.3%) received antibiotics for treatment of acute bronchitis; this total decreased to 924 of 2392 (38.6%; p ≤ 0.001) in 1999, a reduction of 20%. The rate of antibiotic prescribing in control patients was unchanged during the concomitant time periods (142/446, 31.8% vs. 102/321, 31.8%). The rate of subsequent physician visits was similar (8% vs. 9%) between patients receiving antibiotics and those who did not. However, significantly more patients initially receiving antibiotics required a subsequent antibiotic prescription (45/1812, 2.5% vs. 24/2420, 1.0%; p ≤ 0.001). CONCLUSIONS: A pharmacy-based intervention program reduces the incidence of inappropriate antibiotic use in the treatment of acute bronchitis. Reduced antibiotic prescribing does not increase consumption of healthcare resources; patients who receive antibiotics for acute bronchitis are more likely to subsequently require additional antibiotic prescriptions. While a significant decrease in antibiotic use was realized, other interventions are required to further reduce the prevalence of antibiotic use in acute bronchitis.

scholarly journals Development of an Electronic Algorithm to Identify Inappropriate Antibiotic Prescribing for Pediatric Pharyngitis

2020 ◽  
Vol 41 (S1) ◽  
pp. s188-s189
Author(s):  
Jeffrey Gerber ◽  
Robert Grundmeier ◽  
Keith Hamilton ◽  
Lauri Hicks ◽  
Melinda Neuhauser ◽  
...  
Keyword(s):  
Predictive Value ◽  
Gold Standard ◽  
Antibiotic Stewardship ◽  
Chart Review ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Tract Infections ◽  
The Impact

Background: Antibiotic overuse contributes to antibiotic resistance and unnecessary adverse drug effects. Antibiotic stewardship interventions have primarily focused on acute-care settings. Most antibiotic use, however, occurs in outpatients with acute respiratory tract infections such as pharyngitis. The electronic health record (EHR) might provide an effective and efficient tool for outpatient antibiotic stewardship. We aimed to develop and validate an electronic algorithm to identify inappropriate antibiotic use for pediatric outpatients with pharyngitis. Methods: This study was conducted within the Children’s Hospital of Philadelphia (CHOP) Care Network, including 31 pediatric primary care practices and 3 urgent care centers with a shared EHR serving >250,000 children. We used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify encounters for pharyngitis at any CHOP practice from March 15, 2017, to March 14, 2018, excluding those with concurrent infections (eg, otitis media, sinusitis), immunocompromising conditions, or other comorbidities that might influence the need for antibiotics. We randomly selected 450 features for detailed chart abstraction assessing patient demographics as well as practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for evaluating the electronic algorithm. Criteria for appropriate use included streptococcal testing, use of penicillin or amoxicillin (absent β-lactam allergy), and a 10-day duration of therapy. Results: In 450 patients, the median age was 8.4 years (IQR, 5.5–9.0) and 54% were women. On chart review, 149 patients (33%) received an antibiotic, of whom 126 had a positive rapid strep result. Thus, based on chart review, 23 subjects (5%) diagnosed with pharyngitis received antibiotics inappropriately. Amoxicillin or penicillin was prescribed for 100 of the 126 children (79%) with a positive rapid strep test. Of the 126 children with a positive test, 114 (90%) received the correct antibiotic: amoxicillin, penicillin, or an appropriate alternative antibiotic due to b-lactam allergy. Duration of treatment was correct for all 126 children. Using the electronic algorithm, the proportion of inappropriate prescribing was 28 of 450 (6%). The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were sensitivity (99%, 422 of 427); specificity (100%, 23 of 23); positive predictive value (82%, 23 of 28); and negative predictive value (100%, 422 of 422). Conclusions: For children with pharyngitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. Future work should validate this approach in other settings and develop and evaluate the impact of an audit and feedback intervention based on this tool.Funding: NoneDisclosures: None

scholarly journals Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis

2020 ◽  
Vol 41 (S1) ◽  
pp. s32-s32
Author(s):  
Ebbing Lautenbach ◽  
Keith Hamilton ◽  
Robert Grundmeier ◽  
Melinda Neuhauser ◽  
Lauri Hicks ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Predictive Value ◽  
Gold Standard ◽  
Chart Review ◽  
Acute Bronchitis ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Diagnostic Codes ◽  
Icd 10 ◽  
The Impact

Background: Antibiotic resistance has increased at alarming rates, driven predominantly by antibiotic overuse. Although most antibiotic use occurs in outpatients, antimicrobial stewardship programs have primarily focused on inpatient settings. A major challenge for outpatient stewardship is the lack of accurate and accessible electronic data to target interventions. We sought to develop and validate an electronic algorithm to identify inappropriate antibiotic use for outpatients with acute bronchitis. Methods: This study was conducted within the University of Pennsylvania Health System (UPHS). We used ICD-10 diagnostic codes to identify encounters for acute bronchitis at any outpatient UPHS practice between March 15, 2017, and March 14, 2018. Exclusion criteria included underlying immunocompromising condition, other comorbidity influencing the need for antibiotics (eg, emphysema), or ICD-10 code at the same visit for a concurrent infection (eg, sinusitis). We randomly selected 300 (150 from academic practices and 150 from nonacademic practices) eligible subjects for detailed chart abstraction that assessed patient demographics and practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for assessment of the electronic algorithm. Because antibiotic use is not indicated for this study population, appropriateness was assessed based upon whether an antibiotic was prescribed or not. Results: Of 300 subjects, median age was 61 years (interquartile range, 50–68), 62% were women, 74% were seen in internal medicine (vs family medicine) practices, and 75% were seen by a physician (vs an advanced practice provider). On chart review, 167 (56%) subjects received an antibiotic. Of these subjects, 1 had documented concern for pertussis and 4 had excluding conditions for which there were no ICD-10 codes. One received an antibiotic prescription for a planned dental procedure. Thus, based on chart review, 161 (54%) subjects received antibiotics inappropriately. Using the electronic algorithm based on diagnostic codes, underlying and concurrent conditions, and prescribing data, the number of subjects with inappropriate prescribing was 170 (56%) because 3 subjects had antibiotic prescribing not noted based on chart review. The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were the following: sensitivity, 100% (161 of 161); specificity, 94% (130 of 139); positive predictive value, 95% (161 of 170); and negative predictive value, 100% (130 of 130). Conclusions: For outpatients with acute bronchitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. This algorithm could be used to efficiently assess prescribing among practices and individual clinicians. The impact of interventions based on this algorithm should be tested in future studies.Funding: NoneDisclosures: None

scholarly journals 2069. A Unique Approach to Outpatient Antibiotic Stewardship in Rural Southern Ohio

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S697-S698
Author(s):  
Lara K Ramey ◽  
David K Byers ◽  
Eli DeLille
Keyword(s):  
Medical Center ◽  
Acute Bronchitis ◽  
Antibiotic Use ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Provider Education ◽  
Hospital System ◽  
Improvement Rate ◽  
Stewardship Program ◽  
National Quality

Abstract Background A five county rural community in southern Ohio was identified as having significantly higher than average rates of antibiotic use. The hospital system serving this area, Southern Ohio Medical Center (SOMC), began initial efforts in antimicrobial stewardship focusing on inpatient prescribing. However, most antimicrobial consumption occurs in the outpatient setting. Early attempts to improve antibiotic prescribing focused on only provider education and resulted in little change. Providers felt they were performing well, or their patients were more complex and prescribing the antibiotics was warranted. SOMC partnered with the state Quality Improvement Organization, HSAG, to design an intervention to address these challenges. Methods All outpatient and emergency room encounters with acute bronchitis and upper respiratory infection (URI) (ICD-10 codes [J00, J06.9, and J20.X]) were included in the analysis. Using criteria from a National Quality Forum measure, concomitant diagnoses were excluded to identify encounters where an associated condition may indicate the case is more complex. A 6-month baseline and two additional 6-month remeasurement periods were analyzed. Providers were given letters, peer-to-peer antimicrobial data comparison, and in-person feedback with guideline-driven recommendations for these conditions. Results Baseline analysis indicated 50% of all encounters without a coded concomitant diagnosis resulted in antibiotic prescriptions. There was a reduction in the overall rate at each remeasurement period, to 34% and then 12%. This resulted in a 76% relative improvement rate (RIR) overall at the final remeasurement period. At baseline, the highest volume setting, urgent care, had a prescribing rate of 71%. Urgent-care prescriptions reduced each remeasurement to 45% and 13%, resulting in an 81% RIR. Conclusion Implementing a robust outpatient stewardship program in a rural nonacademic setting is not without unique challenges. By using peer comparison of provider performance data on prescribing habits in uncomplicated patients with URI and acute bronchitis in addition to education, the rate of appropriate antibiotic use improved. Disclosures All authors: No reported disclosures.

Impact of an electronic best-practice advisory in combination with prescriber education on antibiotic prescribing for ambulatory adults with acute, uncomplicated bronchitis within a large integrated health system

2019 ◽  
Vol 40 (12) ◽  
pp. 1348-1355 ◽  
Author(s):  
Courtney M. Pagels ◽  
Thomas J. Dilworth ◽  
Lynne Fehrenbacher ◽  
Maharaj Singh ◽  
Charles F. Brummitt
Keyword(s):  
Health System ◽  
Emergency Departments ◽  
Best Practice ◽  
Acute Bronchitis ◽  
Primary Diagnosis ◽  
Urgent Care ◽  
Absolute Difference ◽  
Antibiotic Prescribing ◽  
Practice Advisory ◽  
The Impact

AbstractObjective:To determine the impact of a passive, prescriber-directed, electronic best-practice advisory coupled with prescriber education on the rate of antibiotic prescribing for acute, uncomplicated bronchitis in ambulatory adults across a large health system.Design:This study was a quasi-experiment examining antibiotic prescribing for ambulatory adults with acute bronchitis from January 1, 2016 through December 31, 2018. The intervention was implemented in December 2016 for emergency departments and urgent care clinics followed by ambulatory clinics in September 2017.Setting:Outpatient settings across a health system, including 15 emergency departments, >30 urgent care clinics, and >150 ambulatory clinics.Participants:All adults with a primary diagnosis of acute bronchitis who were seen and discharged from a study site were included.Interventions:A passive, prescriber-directed, best-practice advisory for treatment of acute bronchitis in the electronic health record and an optional, online education module regarding acute bronchitis.Results:The study included 81,975 ambulatory adults with a primary diagnosis of acute bronchitis during the preintervention period (19.8% >65 years of age; 61.9% female) and 89,571 ambulatory adults during the postintervention period (16.5% >65 years of age; 61.1% female). Antibiotic prescribing rates decreased from 60.8% (49,877 of 81,975 patients) preintervention to 51.4% (46,018 of 89,571 patients) postintervention (absolute difference, 9.4%; P < .001). The largest reduction occurred in the emergency departments.Conclusions:An electronic best practice advisory combined with prescriber education was associated with a statistically significant reduction in antibiotic prescribing for adults with acute bronchitis. Future studies should incorporate patient education and address prescriber-reported barriers to appropriate antibiotic prescribing.

scholarly journals 158. Impact of Fluoroquinolone Cascade Reporting of Urine Samples on Antibiotic Prescribing Rates in a Network of Urgent Care Clinics

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S95-S96
Author(s):  
Brittani Weichman ◽  
Amanda Bushman ◽  
Rossana M Rosa
Keyword(s):  
Antibiotic Use ◽  
Outpatient Setting ◽  
Urgent Care ◽  
Fourth Generation ◽  
Selective Reporting ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Inpatient Settings ◽  
Times Series Analysis ◽  
The Impact

Abstract Background Cascade reporting is a type of selective reporting in which susceptibility results of certain antibiotics (either with broader spectrum or cost) are only reported if an organism is resistant to other prespecified agents. This strategy has been successfully deployed in inpatient settings but its impact in outpatient settings is less well characterized. Therefore, we aimed to evaluate the impact of cascade reporting of the antimicrobial susceptibility of fluoroquinolones on prescribing rates of select antibiotics in a network of urban Urgent Care clinics. Methods On July 2019, the susceptibility reporting policies for urine cultures growing Enterobacterales were changed to routinely reporting a limited antibiotic panel including first and second generation cephalosporins, nitrofurantoin and trimethoprim-sulfamethoxazole (TMP-SMX), and fluroquinolone (FQ) reporting was changed to a release only in case of resistance to all agents in the limited panel. Third and fourth generation cephalosporins and carbapenems were reported only in case of resistance to all narrower spectrum agents and FQs. We then compared monthly antibiotic use in prescriptions per 1000 patient-encounters for the pre-intervention (June 2018-June 2019) and post-intervention (August 2019-December 2020) periods using an interrupted times series analysis. Results Immediately following the change to cascade reporting, FQ prescribing decreased by 38% (incidence rate ratio [IRR] 1.38; 95% confidence interval [CI] 0.50-0.77 p&lt; 0.0001) and no change in trend was subsequently seen (IRR 1.01, 95% CI 0.98-1.04; p=0.59) (Figure 1).Cephalexin prescribing did not immediately change following the intervention (IRR 1.20, 95% CI 1.00-1.33; p=0.05) but subsequently showed a trend towards increase use (IRR 1.04, 95% CI 1.02-1.06; p&lt; 0.0001) (Figure 1). No immediate or trend changes in the prescribing rates of TMP-SMX or nitrofurantoin were identified (Figure 1). Conclusion In a network of Urgent Care clinics, cascade reporting of FQ susceptibility in urine cultures growing Enterobacterales resulted in a sustained decrease in FQ prescribing without major shifts towards prescribing of other agents. Cascade reporting should be considered as a feasible antimicrobial stewardship strategy in this outpatient setting. Disclosures All Authors: No reported disclosures

scholarly journals 229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S116-S116
Author(s):  
Julia Sessa ◽  
Helen Jacoby ◽  
Bruce Blain ◽  
Lisa Avery
Keyword(s):  
Patient Care ◽  
Teaching Hospital ◽  
Antimicrobial Stewardship ◽  
Rank Order ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Full Time ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

scholarly journals 154. Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Adults with Acute Pharyngitis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S87-S87
Author(s):  
Ebbing Lautenbach ◽  
Keith W Hamilton ◽  
Robert Grundmeier ◽  
Melinda M Neuhauser ◽  
Lauri Hicks ◽  
...  
Keyword(s):  
Chart Review ◽  
Inappropriate Prescribing ◽  
Antibiotic Use ◽  
University Of Pennsylvania ◽  
Antibiotic Prescribing ◽  
Acute Pharyngitis ◽  
Test Characteristics ◽  
Appropriate Prescribing ◽  
Concurrent Infections ◽  
The Impact

Abstract Background Although most antibiotic use occurs in outpatients, antibiotic stewardship programs (ASPs) have primarily focused on inpatients. A major challenge for outpatient ASPs is lack of accurate and accessible electronic data to target interventions. We developed and validated an electronic algorithm to identify inappropriate antibiotic use for adult outpatients with acute pharyngitis. Methods In the University of Pennsylvania Health System, we used ICD-10 diagnostic codes to identify patient encounters for acute pharyngitis at outpatient practices between 3/15/17 – 3/14/18. Exclusion criteria included immunocompromising conditions, comorbidities, and concurrent infections that might require antibiotic use. We randomly selected 300 eligible subjects. Inappropriate antibiotic use based on chart review served as the basis for assessment of the electronic algorithm which was constructed using only data in the electronic health record (EHR). Criteria for appropriate prescribing, choice of antibiotic, and duration included positive streptococcal testing, use of penicillin/amoxicillin (absent b-lactam allergy), and 10 days maximum duration of therapy. Results Of 300 subjects, median age was 42, 75% were female, 64% were seen by internal medicine (vs. family medicine), and 69% were seen by a physician (vs. advanced practice provider). On chart review, 127 (42%) subjects received an antibiotic, of which 29 had a positive streptococcal test and 4 had another appropriate indication. Thus, 74% (94/127) of patients received antibiotics inappropriately. Of the 29 patients who received appropriate prescribing, 27 (93%) received an appropriate antibiotic. Finally, of the 29 patients who were appropriately treated, 29 (100%) received the correct duration. Test characteristics of the EHR algorithm (compared to chart review) are noted in the Table. Conclusion Inappropriate antibiotic prescribing for acute pharyngitis is common. An electronic algorithm for identifying inappropriate prescribing, antibiotic choice, and duration is highly accurate. This algorithm could be used to efficiently assess prescribing among practices and individual clinicians. The impact of interventions based on this algorithm should be tested in future work. Test Characteristics of Electronic Algorithm for Inappropriate Prescribing, Agent, and Duration Disclosures All Authors: No reported disclosures

scholarly journals An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections

2018 ◽  
Vol 5 (9) ◽  
Author(s):  
Michael J Durkin ◽  
Matthew Keller ◽  
Anne M Butler ◽  
Jennie H Kwon ◽  
Erik R Dubberke ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antibiotic Use ◽  
Emergency Department Visits ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Duration Of Treatment ◽  
Minimal Impact ◽  
Tract Infections ◽  
The Impact

Abstract Background In 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). Recommendations from this CPG were rapidly disseminated to clinicians via review articles, UpToDate, and the Centers for Disease Control and Prevention website; however, it is unclear if this CPG had an impact on national antibiotic prescribing practices. Methods We performed a retrospective cohort study of outpatient and emergency department visits within a commercial insurance database between January 1, 2009, and December 31, 2013. We included nonpregnant women aged 18–44 years who had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a UTI with a concurrent antibiotic prescription. We performed interrupted time series analyses to determine the impact of the CPG on the appropriateness of the antibiotic agent and duration. Results We identified 654 432 women diagnosed with UTI. The patient population was young (mean age, 31 years) and had few comorbidities. Fluoroquinolones, nonfirstline agents, were the most commonly prescribed antibiotic class both before and after release of the guidelines (45% vs 42%). Wide variation was observed in the duration of treatment, with &gt;75% of prescriptions written for nonrecommended treatment durations. The CPG had minimal impact on antibiotic prescribing behavior by providers. Conclusions Inappropriate antibiotic prescribing is common for the treatment of UTIs. The CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs. Further interventions are necessary to improve outpatient antibiotic prescribing for UTIs.

scholarly journals Parental self-medication with antibiotics for children promotes antibiotic over-prescribing in clinical settings in China

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Jiayao Xu ◽  
Xiaomin Wang ◽  
Kai Sing Sun ◽  
Leesa Lin ◽  
Xudong Zhou
Keyword(s):  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Clinical Settings ◽  
Cross Sectional Survey ◽  
Self Medication ◽  
Cross Sectional ◽  
Prescribing Behavior ◽  
The Past ◽  
Outpatient Settings ◽  
The Impact

Abstract Background Self-medication with antibiotics (SMA) is one of the most dangerous inappropriate antibiotic use behaviors. This study aims to investigate the impact of parental SMA for children before a consultation on their doctor’s subsequent antibiotic prescribing behavior, including intravenous (IV) antibiotic use in the clinical setting of China. Methods A cross-sectional survey was conducted between June 2017 and April 2018 in three provinces of China. A total of 9526 parents with children aged 0–13 years were investigated. Data from 1275 parents who had self-medicated their children and then visited a doctor in the past month were extracted and analyzed. Results One-third (410) of the studied children had parental SMA before the consultation and 83.9% of them were subsequently prescribed antibiotics by doctors. Children with parental SMA were more likely to be prescribed antibiotics (aOR = 7.79, 95% CI [5.74–10.58]), including IV antibiotics (aOR = 3.05, 95% CI [2.27–4.11]), and both oral and IV antibiotics (aOR = 3.42, 95% CI [2.42–4.84]), than children without parental SMA. Parents with SMA behaviors were more likely to request antibiotics (aOR = 4.05, 95% CI [2.59–6.31]) including IV antibiotics (aOR = 2.58, 95% CI [1.40–4.76]), and be fulfilled by doctors (aOR = 3.22, 95% CI [1.20–8.63]). Conclusions Tailored health education for parents is required in both community and clinical settings to discourage parental SMA for children. The doctors should not prescribe unnecessary antibiotics to reinforce parents’ SMA behaviors. We recommend expanding the current IV antibiotics ban in outpatient settings of China to cover outpatient pediatrics.

scholarly journals Impact of the COVID-19 pandemic on community antibiotic prescribing in Scotland

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
William Malcolm ◽  
Ronald A Seaton ◽  
Gail Haddock ◽  
Linsey Baxter ◽  
Sarah Thirlwell ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Age Groups ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescription Data ◽  
National Data ◽  
Time Data ◽  
Electronic Messaging ◽  
The Impact ◽  
Selection Of

Abstract Background Following concerns about increased antibiotic use during the COVID-19 pandemic, trends in community antibiotic prescriptions in Scotland were evaluated. Methods The primary care prescription electronic messaging system used in GP practices with NHS contracts provided near real-time data analysis of national data. The main outcome measures were the weekly number of prescriptions for antibiotics generated by prescribers in GP practices in 2020 compared with 2019. Results At end of Week 12 2020 (22 March), after a sharp increase, the number of prescriptions commonly used for respiratory infections was 44% higher than the corresponding week in 2019. The number of prescriptions for respiratory antibiotics reduced through April and May 2020, with 34% fewer prescriptions issued by end of Week 22 (31 May) than in the corresponding week in 2019. Reductions were pronounced in all age groups but particularly apparent for prescriptions for children aged 0–4 years. These data were compared with weekly prescriptions for a selection of non-respiratory antibiotics and no difference was seen between 2020 and 2019. Conclusions Trends in antibiotic prescription data show that after an initial surge, and following ‘lockdown’ in Scotland, the total number of prescriptions for antibiotics commonly used for respiratory infections fell. We believe this is the first published national evaluation of the impact of COVID-19 on community use of antibiotics. Further analysis of national data is planned to provide a greater understanding of the reasons behind these trends.

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