Delayed prescribing of antibiotics for self-limiting respiratory tract infections in an urgent care out-of-hours setting

2020 ◽  
Vol 2 (3) ◽  
pp. 130-135
Author(s):  
Justine Dexter ◽  
Gerri Mortimore
Keyword(s):  
Antimicrobial Resistance ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Out Of Hours ◽  
Advantages And Disadvantages ◽  
Health And Social Care ◽  
Tract Infections

Long-term overuse of antibiotics and inappropriate prescribing has led to widespread development of antimicrobial resistance. The Department of Health and Social Care recently published a five-year national action plan to reduce antimicrobial resistance, with the aim of reducing inappropriate antibiotic prescribing. This is mirrored in the NHS Long Term Plan, which aims to reduce unintentional exposure through a combination of antibiotic stewardship and leadership at all levels. An acute respiratory tract infection is one of the most common presentations in primary care, with 16.7% of all prescriptions issued attributed to it. Therefore, out-of-hours prescribers contribute significantly to general antibiotic consumption. This article analyses the practice of delayed prescribing of antibiotics for the treatment of self-limiting respiratory tract infections in an out-of-hours service. The advantages and disadvantages associated with delayed prescribing, to safely treat patients whilst facilitating the reduction of antimicrobial resistance, are discussed. In addition, recommendations for future practice are offered. This article also focuses on the development of an advanced nurse practitioner, reflecting on the four pillars of advanced practice, which underpin advanced clinical practice and associated competencies.

scholarly journals 2060. Evaluation of a Pharmacist’s Impact on Antimicrobial Prescribing in an Urgent Care Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S694-S694
Author(s):  
Amy Fabian ◽  
Sara Linnertz ◽  
Lisa Avery
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Viral Infections ◽  
Care Center ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Composite Outcome ◽  
Post Intervention ◽  
Urgent Care Center ◽  
Tract Infections

Abstract Background The urgent care center (UC) setting is an opportunity for pharmacists to promote antimicrobial stewardship (AS). The primary objective is to determine compliance with antibiotic prescribing recommendations for the treatment of urinary tract infections (UTIs), skin and soft-tissue infections (SSTIs), upper respiratory tract infections (URIs), and lower respiratory tract infections (LRTIs) before, during, and after the presence of an AS pharmacist in an UC. Methods Single-center, retrospective, observational, pre (December 10, 2018–January 6, 2019), intervention (January 7–February 3, 2019), and post-intervention (February 4–March 3, 2019) study. All non-pregnant, adult patients with a chief complaint consistent with UTI, SSTI, URI, or LRTI were included. Patients transferred to another facility, presented for a follow-up visit, with multiple sites of infection, or treated for a bite, wound, or surgical site infection were excluded. Noncompliance (NC) was a composite endpoint of non-guideline adherent antibiotic prescribing for viral infections, inappropriate empiric selection, duration, and/or dosage. Secondary outcomes include composite outcome components and subgroup analysis of disease states. Results A total of 1,930 patients were screened with 439,440, and 430 patients included in the pre, intervention, and post-intervention group. Demographics were similar between groups, except for age (P = 0.001) and influenza diagnoses (P < 0.001). NC decreased from 43.3% to 31.1% (P = 0.0002) pre-intervention to intervention and from 31.1% to 26.5% (P = 0.14) post-intervention. Pre-intervention to intervention resulted in a change in composite outcome components of non-compliant prescribing (18.9% to 13%, P = 0.02), empiric selection (8.7% to 5.9%, P = 0.12), duration (4.1% to 5.9%, P = 0.28), dosage (3.4% to 0.5%, P = 0.001), and multiple components for NC (8.2% to 6.4%, P = 0.3). Reductions in NC were seen for UTI (83.3% to 69.2%, P = 0.26), SSTI (45.7% to 42.9%, P = 1.0), URI (23.5% to 23.2%, P = 1.0), and LRTI (82.1% to 51.6%, P = 0.0004). Conclusion An AS pharmacist’s presence in a UC significantly reduced NC to antibiotic prescribing recommendations. The largest impact was in reducing antibiotic treatment of viral infections and optimizing antibiotic dosing. Disclosures All authors: No reported disclosures.

scholarly journals Homeopathy in the Age of Antimicrobial Resistance: Is It a Viable Treatment for Upper Respiratory Tract Infections?

Homeopathy ◽  
2018 ◽  
Vol 107 (02) ◽  
pp. 099-114 ◽  
Author(s):  
Alison Fixsen
Keyword(s):  
Antimicrobial Resistance ◽  
Respiratory Tract ◽  
Cohort Studies ◽  
Respiratory Tract Infections ◽  
Upper Respiratory Tract Infections ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Long Term Effects ◽  
Upper Respiratory ◽  
Tract Infections

Background Acute upper respiratory tract infections (URTIs) and their complications are the most frequent cause of antibiotic prescribing in primary care. With multi-resistant organisms proliferating, appropriate alternative treatments to these conditions are urgently required. Homeopathy presents one solution; however, there are many methods of homeopathic prescribing. This review of the literature considers firstly whether homeopathy offers a viable alternative therapeutic solution for acute URTIs and their complications, and secondly how such homeopathic intervention might take place. Method Critical review of post 1994 clinical studies featuring homeopathic treatment of acute URTIs and their complications. Study design, treatment intervention, cohort group, measurement and outcome were considered. Discussion focused on the extent to which homeopathy is used to treat URTIs, rate of improvement and tolerability of the treatment, complications of URTIs, prophylactic and long-term effects, and the use of combination versus single homeopathic remedies. Results Multiple peer-reviewed studies were found in which homeopathy had been used to treat URTIs and associated symptoms (cough, pharyngitis, tonsillitis, otitis media, acute sinusitis, etc.). Nine randomised controlled trials (RCTs) and 8 observational/cohort studies were analysed, 7 of which were paediatric studies. Seven RCTs used combination remedies with multiple constituents. Results for homeopathy treatment were positive overall, with faster resolution, reduced use of antibiotics and possible prophylactic and longer-term benefits. Conclusions Variations in size, location, cohort and outcome measures make comparisons and generalisations concerning homeopathic clinical trials for URTIs problematic. Nevertheless, study findings suggest at least equivalence between homeopathy and conventional treatment for uncomplicated URTI cases, with fewer adverse events and potentially broader therapeutic outcomes. The use of non-individualised homeopathic compounds tailored for the paediatric population merits further investigation, including through cohort studies. In the light of antimicrobial resistance, homeopathy offers alternative strategies for minor infections and possible prevention of recurring URTIs.

scholarly journals Antibiotic Prescribing and Doctor-Patient Communication During Consultations for Respiratory Tract Infections: A Video Observation Study in Out-of-Hours Primary Care

2021 ◽  
Vol 8 ◽  
Author(s):  
Annelies Colliers ◽  
Katrien Bombeke ◽  
Hilde Philips ◽  
Roy Remmen ◽  
Samuel Coenen ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
General Practitioners ◽  
Communication Skills ◽  
Respiratory Tract Infections ◽  
Patient Expectations ◽  
Antibiotic Prescribing ◽  
Out Of Hours ◽  
Doctor Patient Communication ◽  
Tract Infections

Objective: Communication skills can reduce inappropriate antibiotic prescribing, which could help to tackle antibiotic resistance. General practitioners often overestimate patient expectations for an antibiotic. In this study, we describe how general practitioners and patients with respiratory tract infections (RTI) communicate about their problem, including the reason for encounter and ideas, concerns, and expectations (ICE), and how this relates to (non-)antibiotic prescribing in out-of-hours (OOH) primary care.Methods: A qualitative descriptive framework analysis of video-recorded consultations during OOH primary care focusing on doctor-patient communication.Results: We analyzed 77 videos from 19 general practitioners. General practitioners using patient-centered communication skills received more information on the perspective of the patients on the illness period. For some patients, the reason for the encounter was motivated by their belief that a general practitioner (GP) visit will alter the course of their illness. The ideas, concerns, and expectations often remained implicit, but the concerns were expressed by the choice of words, tone of voice, repetition of words, etc. Delayed prescribing was sometimes used to respond to implicit patient expectations for an antibiotic. Patients accepted a non-antibiotic management plan well.Conclusion: Not addressing the ICE of patients, or their reason to consult the GP OOH, could drive assumptions about patient expectations for antibiotics early on and antibiotic prescribing later in the consultation.

scholarly journals Antibiotic prescribing for acute, non-complicated infections in primary care in Germany: baseline assessment in the cluster randomized trial ARena

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Regina Poss-Doering ◽  
Dorothea Kronsteiner ◽  
Martina Kamradt ◽  
Edith Andres ◽  
Petra Kaufmann-Kolle ◽  
...  
Keyword(s):  
Primary Care ◽  
Antimicrobial Resistance ◽  
Respiratory Tract ◽  
General Practitioners ◽  
Respiratory Tract Infections ◽  
Reference Group ◽  
Antibiotic Prescribing ◽  
Tract Infections ◽  
Rational Use Of Antibiotics ◽  
To Receive

Abstract Background Antimicrobial resistance is fueled by inappropriate use of antibiotics. Global and national strategies support rational use of antibiotics to retain treatment options and reduce resistance. In Germany, the ARena project (Sustainable reduction of antibiotic-induced antimicrobial resistance) intended to promote rational use of antibiotics for acute non-complicated infections by addressing network-affiliated physicians, primary care teams and patients through multiple interacting interventions. The present study documented patterns of antibiotic prescribing for patients with acute non-complicated infections who consulted a physician in these networks at the start of the ARena project. It explored variation across subgroups of patients and draws comparisons to prescribing patterns of non-targeted physicians. Methods This retrospective cross-sectional analysis used mixed logistic regression models to explore factors associated with the primary outcome, which was the percentage of patient cases with acute non-complicated respiratory tract infections consulting primary care practices who were treated with antibiotics. Secondary outcomes concerned the prescribing of different types of antibiotics. Descriptive methods were used to summarize the data referring to targeted physicians in primary care networks, non-targeted physicians (reference group), and patient subgroups. Results Overall, antibiotic prescribing rates were 32.0% in primary care networks and 31.7% in the reference group. General practitioners prescribed antibiotics more frequently than other medical specialist groups (otolaryngologists vs. General practitioners OR = 0.465 CI = [0.302; 0.719], p < 0.001, pediatricians vs. General practitioners: OR = 0.369 CI = [0.135; 1.011], p = 0.053). Quinolone prescribing rates were 9.9% in primary care networks and 8.1% in reference group. Patients with comorbidities had a higher likelihood of receiving an antibiotic and quinolone prescription and were less likely to receive a guideline-recommended substance. Younger patients were less likely to receive antibiotics (OR = 0.771 CI = [0.636; 0.933], p = 0.008). Female gender was more likely to receive an antibiotic prescription (OR = 1.293 CI = [1.201, 1.392], p < 0.001). Conclusion This study provided an overview of observed antibiotic prescribing for acute non-complicated respiratory tract infections in German primary care at the start of the ARena project. Findings indicate potential for improvement and will serve as comparator for the post-interventional outcome evaluation to facilitate describing of potential changes.

scholarly journals Optimizing antibiotic prescribing for acute respiratory tract infections in an urban urgent care clinic

2003 ◽  
Vol 18 (5) ◽  
pp. 326-334 ◽  
Author(s):  
Robert H. Harris ◽  
Thomas D. MacKenzie ◽  
Bonnie Leeman-Castillo ◽  
Kitty K. Corbett ◽  
Holly A. Batal ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Care Clinic ◽  
Acute Respiratory Tract Infections ◽  
Urgent Care Clinic ◽  
Tract Infections

scholarly journals Long-term effect of a practice-based intervention (HAPPY AUDIT) aimed at reducing antibiotic prescribing in patients with respiratory tract infections

2018 ◽  
Vol 73 (8) ◽  
pp. 2215-2222 ◽  
Author(s):  
Carl Llor ◽  
Lars Bjerrum ◽  
José M Molero ◽  
Ana Moragas ◽  
Beatriz González López-Valcárcel ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Term Effect ◽  
Antibiotic Prescribing ◽  
Long Term Effect ◽  
Tract Infections

scholarly journals Antimicrobial Resistance of 1,113Streptococcus pneumoniae Isolates from Patients with Respiratory Tract Infections in Spain: Results of a 1-Year (1996–1997) Multicenter Surveillance Study

1999 ◽  
Vol 43 (2) ◽  
pp. 357-359 ◽  
Author(s):  
Fernando Baquero ◽  
José Angel García-Rodríguez ◽  
Juan García de Lomas ◽  
Lorenzo Aguilar ◽  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Antimicrobial Resistance ◽  
Respiratory Tract ◽  
Middle Ear ◽  
Respiratory Tract Infections ◽  
Surveillance Study ◽  
High Frequencies ◽  
Resistant Strains ◽  
Tract Infections

A nationwide susceptibility surveillance of 1,113Streptococcus pneumoniae isolates was carried out and found the following percentages of resistance: cefuroxime, 46%; penicillin, 37%; macrolides, 33%; aminopenicillins, 24%; cefotaxime, 13%; and ceftriaxone, 8%. A significant (P < 0.05) seasonality pattern for β-lactam antibiotics was observed. Resistance to macrolides was higher (P < 0.05) in middle-ear samples. Higher percentages of resistance to cefuroxime and macrolides were observed among penicillin-intermediate and -resistant strains, whereas high frequencies of resistance to aminopenicillins and expanded-spectrum cephalosporins were observed only among penicillin-resistant strains.

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