Does the problem begin at the beginning? Medical students’ knowledge and beliefs regarding antibiotics and resistance: a systematic review

Abstract Background Studies have detected that prescribers display gaps in knowledge and inappropriate attitudes regarding antibiotics and resistances, but it is not known whether these are generated during professional practice or derive from the undergraduate stage of their education. Accordingly, the aim of this study was to identify medical students’ knowledge, beliefs and attitudes regarding antibiotic use and antibiotic resistance, and whether these change over the course of their time at medical school. Methods We conducted a search of the MEDLINE and EMBASE databases, and included studies that measured knowledge and/or beliefs and/or attitudes regarding antibiotic prescribing and/or resistance, among medical students. Results Of the 509 studies retrieved, 22 met the inclusion criteria. While medical students perceived resistance as posing a major public health problem, both worldwide and in their own countries, students in the last two course years were more aware of overprescription of antibiotics in general, and of broad-spectrum antibiotics, at their teaching hospital. There was a considerable lack of knowledge about the treatment of high-incidence infections, and upper respiratory tract infections in particular (41–69% of participants believed antibiotics to be useful for treating these), without any differences by course year. Students were conscious of their personal shortcomings and thus showed willing to improve their education. Conclusions Future physicians display important gaps in knowledge, particularly in terms of treatment of high-incidence infections. This finding may be of use when it comes to designing more effective training in antibiotic stewardship for undergraduates.

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Knowledge, Attitudes, and Reported Practices Among Obstetrician-Gynecologists in the USA Regarding Antibiotic Prescribing for Upper Respiratory Tract Infections

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2005/405868 ◽

2005 ◽

Vol 13 (1) ◽

pp. 17-24 ◽

Cited By ~ 14

Author(s):

Shadi Chamany ◽

Jay Schulkin ◽

Charles E. Rose ◽

Laura E. Riley ◽

Richard E. Besser

Keyword(s):

Primary Care ◽

Respiratory Tract Infections ◽

Antibiotic Use ◽

Upper Respiratory Tract Infections ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Office Visits ◽

The Common ◽

Upper Respiratory ◽

Tract Infections

Background:Knowledge, attitudes, and practices regarding antibiotic prescribing for upper respiratory tract infections (URIs) have not been well described among obstetrician-gynecologists (OB/GYNs). This information is useful for determining whether an OB/GYN-specific program promoting appropriate antibiotic use would significantly contribute to the efforts to decrease inappropriate antibiotic use among primary care providers.Methods:An anonymous questionnaire asking about the treatment of URIs was sent to 1031 obstetrician-gynecologists.Results:The overall response rate was 46%. The majority of respondents (92%) were aware of the relationship between antibiotic use and antibiotic resistance, and respondents estimated that 5% of their patients had URI symptoms at their office visits. Overall, 56% of respondents reported that they would prescribe an antibiotic for uncomplicated bronchitis and 43% for the common cold. OB/GYNs with the fewest years of experience were less likely than those with the most years of experience to report prescribing for uncomplicated bronchitis (Odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23 to 0.91) or the common cold (OR 0.44, CI 0.22 to 0.89). The majority of respondents (60%) believed that most patients wanted an antibiotic for URI symptoms, with male OB/GYNs being more likely than female OB/GYNs (OR 2.1, CI 1.2 to 3.8) to hold this belief. Both male OB/GYNs (OR 1.9, CI 1.1 to 3.4) and rural practitioners (OR 2.1, CI 1.1 to 4.0) were more likely to believe that it was hard to withhold antibiotics for URI symptoms because other physicians prescribe antibiotics for these symptoms. OB/GYNs who believed that postgraduate training prepared them well for primary care management were more likely than those who did not (OR 2.1, CI 1.1 to 4.2) to believe that they could reduce antibiotic prescribing without reducing patient satisfaction.Conclusion:Multiple demographic factors affect attitudes and reported practices regarding antibiotic prescribing. However, in view of the low proportion of office visits for URIs, an OB/GYN-specific program is not warranted.

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1135. The Effect of Penicillin Allergy Labels on Antibiotic Prescribing for Children Diagnosed with Upper Respiratory Tract Infections in Two Primary Care Networks

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1328 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S658-S659

Author(s):

Torsten Joerger ◽

Margaret Taylor ◽

Debra Palazzi ◽

Jeffrey Gerber

Keyword(s):

Broad Spectrum ◽

Respiratory Tract Infections ◽

Antibiotic Use ◽

Upper Respiratory Tract Infections ◽

Antibiotic Prescribing ◽

Second Line ◽

Upper Respiratory Tract ◽

Broad Spectrum Antibiotic ◽

Upper Respiratory ◽

Tract Infections

Abstract Background In pediatric inpatient settings, unconfirmed penicillin allergy labels (PALs) are associated with increased broad-spectrum antibiotic use, costs, and adverse events. However, 90% of antibiotics are prescribed in the outpatient setting and 70% of these antibiotics are given for upper respiratory tract infections (URTI.) Little is known about the effect of PALs on antibiotic prescribing in the pediatric outpatient population. Methods A retrospective birth cohort was created of children born between January 1st 2010 and June 30th 2020 and seen at one of 91 Texas Children’s Pediatrics or Children’s Hospital of Philadelphia primary care clinics. Children with an ICD10 code for an URTI and an antibiotic prescription were stratified into those with or without a penicillin allergy label at the time of the infection. Rates of second-line and broad-spectrum antibiotic use were compared. Results The birth cohort included 334,465 children followed for 1.2 million person-years. An antibiotic was prescribed for 696,782 URTIs and the most common diagnosis was acute otitis media. Children with PALs were significantly more likely to receive second-line antibiotics (OR 35.0, 95% CI 33.9-36.1) and broad-spectrum antibiotics (OR 23.9, 95% CI 23.2-24.8.) Children with PALs received more third generation cephalosporins (60% vs. 15%) and more macrolide antibiotics (25% vs. 3%) than those without a PAL. Overall, 18,015 children (5.4%) acquired a PAL during the study period, which accounted for 23% of all second-line antibiotic prescriptions and 17% of all broad-spectrum antibiotic use for URTIs. Multivariable logistic regression for receipt of second-line antibiotics for upper respiratory tract infections Conclusion PALs are common and account for a substantial proportion of second-line and broad-spectrum antibiotic use in pediatric outpatients treated for URTIs. Efforts to de-label children with PALs are likely to increase first-line antibiotic use and decrease broad-spectrum antibiotic use for URTIs, the most common indication for antibiotic prescribing to children. Disclosures Debra Palazzi, MD, MEd, AAP (Other Financial or Material Support, PREP ID Editorial Board, PREP ID Course)AHRQ (Research Grant or Support)Elsevier (Other Financial or Material Support, Royalties for writing and editing chapters)JAMA Pediatrics (Board Member)

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1118. Trends of Paediatric Prescribing for Common Infections in British Columbia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.982 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S397-S397

Author(s):

Ariana Saatchi ◽

David M Patrick ◽

James McCormack ◽

Andrew Morris ◽

Fawziah Marra

Keyword(s):

Urinary Tract ◽

Respiratory Tract ◽

Urinary Tract Infections ◽

Respiratory Tract Infections ◽

Antibiotic Use ◽

Pediatric Care ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Tract Infections

Abstract Background Antibiotic prescribing in pediatric care is highly prevalent, and quite often children are prescribed for conditions which are commonly self-limiting and viral in etiology. The purpose of this study was to examine the scope of pediatric antibiotic prescribing by indication, from 2013 to 2016, and identify potential new targets for provincial antimicrobial stewardship efforts. Methods Antibiotic prescription data for children were extracted from a provincial prescription database, and linked to physician billing data in order to obtain diagnostic information. Prescription rates were then calculated, and trends were examined by indication. Major categories included: upper respiratory tract infection, acute otitis media, lower respiratory tract, skin and soft tissue, and urinary tract infections. Results Our database included an average of 244,763 children per year, and 5,896,173 total antibiotic prescriptions. Increased indication-specific rates of prescribing were observed in children aged 0–2 years, for every category. Children aged 3–18 years experienced decreased prescribing across all indications, with the exception of urinary tract infections for those aged between 10–18 years. Urinary tract infections increased by 134% for children aged 0–2 years, and 75% for those aged 10–18 years, from 2013 to 2016. Although antibiotic use for upper respiratory tract infections decreased by 11% for all ages, these diagnoses continue to be prescribed for at rates 2 – 5 times higher than other conditions. Conclusion Although this study found a decrease in prescribing over time across all indications, antibiotic use continues to be a concern for upper respiratory tract infections in pediatric care. These diagnoses generally do not require antibiotics, and inappropriate prescribing is a major factor in antimicrobial resistance. The increased prescribing rates in the youngest age group (0–2 years) offers a new target for provincial stewardship efforts. Disclosures All authors: No reported disclosures.

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Antibiotics and the development of resistant microorganisms. Can homeopathy be an alternative?

Homeopathy ◽

10.1016/s1475-4916-03-00016-x ◽

2003 ◽

Vol 92 (02) ◽

pp. 99-107

Author(s):

Petter Viksveen

Keyword(s):

Antibiotic Resistance ◽

Public Health Problem ◽

Animal Husbandry ◽

Resistant Bacteria ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Global Public Health ◽

Agricultural Applications ◽

Tract Infections ◽

Almost All

AbstractAntibiotic resistance is a global public health problem. Once confined primarily to hospitals it is now increasingly common in primary care. The prevalence of resistant bacteria is rising, and organisms resistant to almost all antibiotics have been identified. The main causes are indiscriminate prescribing and the use of antibiotics in animal feeds and other agricultural applications. Policies to restrict use of antibiotics have had limited success. Homeopathy may have a role to play in combating the development of antibiotic resistance. Clinical research suggests that homeopathy is effective in the treatment of upper respiratory tract infections in children, a frequent cause of inappropriate antibiotic prescribing. The EU recommends the use of homeopathy in organic animal husbandry, and it is used by significant numbers of farmers. At present there is little data on the effectiveness of homeopathy in this setting. Further research should be done.

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A study of antibiotic prescribing: the experience of Lithuanian and Russian GPs

Open Medicine ◽

10.2478/s11536-012-0062-4 ◽

2012 ◽

Vol 7 (6) ◽

pp. 790-799 ◽

Cited By ~ 1

Author(s):

Lina Jaruseviciene ◽

Ruta Radzeviciene-Jurgute ◽

Jeffrey Lazarus ◽

Arnoldas Jurgutis ◽

Ingvar Ovhed ◽

...

Keyword(s):

Respiratory Tract ◽

Respiratory Tract Infections ◽

Antibiotic Use ◽

Upper Respiratory Tract Infections ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Tract Infections ◽

Decision Making Model ◽

Physician Patient

AbstractBackground. Globally, general practitioners (GPs) write more than 90% of all antibiotic prescriptions. This study examines the experiences of Lithuanian and Russian GPs in antibiotic prescription for upper respiratory tract infections, including their perceptions of when it is not indicated clinically or pharmacologically. Methods. 22 Lithuanian and 29 Russian GPs participated in five focus group discussions. Thematic analysis was used to analyse the data. Results. We identified four main thematic categories: patients’ faith in antibiotics as medication for upper respiratory tract infections; patient potential to influence a GP’s decision to prescribe antibiotics for upper respiratory tract infections; impediments perceived by GPs in advocating clinically grounded antibiotic prescribing with their patients, and strategies applied in physician-patient negotiation about antibiotic prescribing for upper respiratory tract infections. Conclusions. Understanding the nature of physician-patient interaction is critical to the effective pursuit of clinically grounded antibiotic use as this study undertaken in Lithuania and the Russian Federation has shown. Both physicians and patients must be targeted to ensure correct antibiotic use. Further, GPs should be supported in enhancing their communication skills about antibiotic use with their patients and encouraged to implement a shared decision-making model in their practices.

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Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00209-16 ◽

2016 ◽

Vol 60 (7) ◽

pp. 4106-4118 ◽

Cited By ~ 59

Author(s):

Rachel McKay ◽

Allison Mah ◽

Michael R. Law ◽

Kimberlyn McGrail ◽

David M. Patrick

Keyword(s):

Respiratory Tract ◽

Respiratory Tract Infections ◽

Multivariable Analysis ◽

Signs And Symptoms ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Medical Subject Headings ◽

Factors Associated ◽

Tract Infections

ABSTRACTAntibiotic use is a modifiable driver of antibiotic resistance. In many circumstances, antibiotic use is overly broad or unnecessary. We systematically assessed factors associated with antibiotic prescribing for respiratory tract infections (RTI). Studies were included if they used actual (not self-reported or intended) prescribing data, assessed factors associated with antibiotic prescribing for RTIs, and performed multivariable analysis of associations. We searched Medline, Embase, and International Pharmaceutical Abstracts using keyword and MeSH (medical subject headings) search terms. Two authors reviewed each abstract and independently appraised all included texts. Data on factors affecting antibiotic prescribing were extracted. Our searches retrieved a total of 2,848 abstracts, with 97 included in full-text review and 28 meeting full inclusion criteria. Compared to other factors, diagnosis of acute bronchitis was associated with increased antibiotic prescribing (range of adjusted odds ratios [aOR], 1.56 to 15.9). Features on physical exam, such as fever, purulent sputum, abnormal respiratory exam, and tonsillar exudate, were also associated with higher odds of antibiotic prescribing. Patient desire for an antibiotic was not associated or was modestly associated with prescription (range of aORs, 0.61 to 9.87), in contrast to physician perception of patient desire for antibiotics, which showed a stronger association (range of aORs, 2.11 to 23.3). Physician's perception of patient desire for antibiotics was strongly associated with antibiotic prescribing. Antimicrobial stewardship programs should continue to expand in the outpatient setting and should emphasize clear and direct communication between patients and physicians, as well as signs and symptoms that do and do not predict bacterial etiology of upper respiratory tract infections.

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Antibiotic prescribing for residents in long-term-care facilities across the UK

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz008 ◽

2019 ◽

Vol 74 (5) ◽

pp. 1447-1451 ◽

Cited By ~ 6

Author(s):

Tracey Thornley ◽

Diane Ashiru-Oredope ◽

Andrew Normington ◽

Elizabeth Beech ◽

Philip Howard

Keyword(s):

Long Term Care ◽

Antibiotic Use ◽

Vulnerable Population ◽

Antibiotic Prescribing ◽

Major Public Health Problem ◽

Term Care ◽

Data Set ◽

Care Facilities ◽

Tract Infections

Abstract Background Antimicrobial resistance (AMR) is a major public health problem. Elderly residents in long-term-care facilities (LTCFs) are frequently prescribed antibiotics, particularly for urinary tract infections. Optimizing appropriate antibiotic use in this vulnerable population requires close collaboration between NHS healthcare providers and LTCF providers. Objectives Our aim was to identify and quantify antibiotic prescribing in elderly residents in UK LTCFs. This is part of a wider programme of work to understand opportunities for pharmacy teams in the community to support residents and carers. Methods This was a retrospective longitudinal cohort study. Data were extracted from a national pharmacy chain database of prescriptions dispensed for elderly residents in UK LTCFs over 12 months (November 2016–October 2017). Results Data were analysed for 341536 residents in LTCFs across the four UK nations, from which a total of 544796 antibiotic prescriptions were dispensed for 167002 residents. The proportion of residents prescribed at least one antibiotic over the 12 month period varied by LTCF, by month and by country. Conclusions Whilst national data sets on antibiotic prescribing are available for hospitals and primary care, this is the first report on antibiotic prescribing for LTCF residents across all four UK nations, and the largest reported data set in this setting. Half of LTCF residents were prescribed at least one antibiotic over the 12 months, suggesting that there is an opportunity to optimize antibiotic use in this vulnerable population to minimize the risk of AMR and treatment failure. Pharmacy teams are well placed to support prudent antibiotic prescribing and improved antimicrobial stewardship in this population.

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1302. Antibiotic Prescribing Knowledge: A Brief Survey of Providers and Staff at an Ambulatory Cancer Center During Antibiotic Awareness Week 2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1135 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S398-S398

Author(s):

Erica Stohs ◽

Elizabeth M Krantz ◽

Ania Sweet ◽

Jacqlynn Zier ◽

Maria Paleologos ◽

...

Keyword(s):

Hematopoietic Cell Transplantation ◽

Antibiotic Use ◽

Cancer Center ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Convenience Sample ◽

Stewardship Program ◽

Tract Infections

Abstract Background Antibiotics have contributed significantly to advances in cancer therapy and hematopoietic cell transplantation, but rising antibiotic resistance threatens this progress. Little is known about knowledge and perceptions surrounding antibiotic use and resistance among staff at cancer centers. Methods We conducted a brief cross-sectional survey of healthcare professionals (HCP) at a large ambulatory cancer center to assess knowledge of antibiotic prescribing and resistance during Antibiotic Awareness Week, November 13–19, 2017. A convenience sample of providers and staff who participated in one of two 2-hour Antimicrobial Stewardship Program “open house” events was used. Questions evaluated knowledge about antibiotic use for upper respiratory tract infections (URIs). Results There were 179 respondents. The proportion of correct responses to each question by employee type is displayed in Table 1. There was a statistically significant decreasing trend in the proportion correctly answering all four questions by employee type from providers, to pharmacists, to nurses, to others (P <0.001) (Figure 1). Conclusion Providers were more likely to correctly answer questions pertaining to antibiotic use compared with other HCP. Due to the multidisciplinary nature of cancer care, patients often encounter a variety of HCP over the course of treatment. Opportunities exist to improve antibiotic stewardship education across the spectrum of HCP at our cancer center, including pharmacists, nurses, and other staff. Disclosures All authors: No reported disclosures.

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1303. Provider Knowledge and Attitudes Toward Antibiotic Prescribing and Antibiotic Stewardship in Outpatient Rural Clinics

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1136 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S398-S399

Author(s):

Wesley Kufel ◽

Bryan Mogle ◽

Karen Williams ◽

James Jester ◽

John Snyder ◽

...

Keyword(s):

New York ◽

Antibiotic Stewardship ◽

Antibiotic Use ◽

Rural Setting ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Cross Sectional ◽

Knowledge And Attitudes ◽

Healthcare Needs ◽

Tract Infections

Abstract Background Rural outpatient clinics serve the healthcare needs of many individuals, especially for acute sick visits and infectious processes. A better understanding of providers’ knowledge and attitudes toward antibiotic stewardship in the outpatient rural setting is needed to facilitate more effective education regarding appropriate antibiotic prescribing. Methods A cross-sectional, multi-center, 28-item survey assessing providers’ knowledge and attitudes toward antibiotic prescribing and antibiotic stewardship in the rural setting was distributed to providers from Guthrie and United Health Services primary care clinics in rural New York and Pennsylvania. Results Sixty-five providers participated (31% response rate) with 43%, 29%, and 28% of responses from physicians, resident physicians, and advanced practice providers, respectively. More than half of respondents practiced for ≤5 years since terminal training. The most significant barrier to improving antibiotic prescribing was patient demands (55%) followed by uncertain diagnosis of bacterial infection (22%) and short appointment visit times (11%). Providers that spent ≤20 minutes per visit were more likely to feel pressured to prescribe antibiotics for upper respiratory tract infections (URI) to ensure patient satisfaction than those who spent >20 minutes (41% vs. 7%, P = 0.024). Additionally, providers who saw >50 patients per week were more likely to feel pressured to prescribe antibiotics for URIs than those who saw ≤50 patients (50% vs. 18%, P = 0.009). Only 42% of providers selected the correct answer that 90–98% of URIs are viral. The majority of providers strongly agreed that antibiotics are overused (71%) and inappropriate antibiotic use can lead to resistance (82%). Thirty-eight percent of providers never heard the term antibiotic stewardship or heard the term but were unsure about the definition. However, more than 75% of providers strongly agreed or agreed that they were interested in receiving more education regarding antibiotic stewardship. Conclusion Variability exists among providers’ knowledge and attitudes toward antibiotic stewardship and antibiotic prescribing in rural outpatient settings. Increased educational efforts are warranted to increase consistency of these concepts and practices. Disclosures All authors: No reported disclosures.

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