Effectiveness of physician-targeted interventions to improve antibiotic use for respiratory tract infections.

Effectiveness of physician-targeted interventions to improve antibiotic use for respiratory tract infections.

Dec 2021

van der Velden AW, Pijpers EJ, Kuyvenhoven MM, Tonkin-Crine SK, Little P, Verheij TJ.

Source

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.

Abstract

BACKGROUND:

Antibiotic use and concomitant resistance are increasing. Literature reviews do not unambiguously indicate which interventions are most effective in improving antibiotic prescribing practice.

AiM:

To assess the effectiveness of physician-targeted interventions aiming to improve antibiotic prescribing for respiratorytract infections (RTIs) in primary care, and to identify intervention features mostly contributing to intervention success.

DESIGN AND SETTING:

Analysis of a set of physician-targeted interventions in primary care.

METHOD:

A literature search (1990-2009) for studies describing the effectiveness of interventions aiming to optimise antibiotic prescription for RTIs by primary care physicians. Intervention features were extracted and effectiveness sizes were calculated. Association between intervention features and intervention success was analysed in multivariate regression analysis.

RESULTS:

This study included 58 studies, describing 87 interventions of which 60% significantly improved antibioticprescribing; interventions aiming to decrease overall antibiotic prescription were more frequently effective than interventions aiming to increase first choice prescription. On average, antibiotic prescription was reduced by 11.6%, and first choice prescription increased by 9.6%. Multiple interventions containing at least 'educational material for the physician' were most often effective. No significant added value was found for interventions containing patient-directed elements. Communication skills training and near-patient testing sorted the largest intervention effects.

CONCLUSION:

This review emphasises the importance of physician education in optimising antibiotic use. Further research should focus on how to provide physicians with the relevant knowledge and tools, and when to supplement education with additional intervention elements. Feasibility should be included in this process.

PubMed

Reasons for inappropriate prescribing of antibiotics in a high-complexity pediatric hospital

Dec 2011

[Article in Spanish]

Ruvinsky S, Mónaco A, Pérez G, Taicz M, Inda L, Kijko I, Constanzo P, Bologna R.

Abstract

OBJECTIVE:

Determine the reasons for inappropriate prescription of antibiotics and identify opportunities to improve prescription of these drugs in pediatric patients hospitalized in intermediate and intensive care units.

METHODS:

A prospective, descriptive longitudinal study was conducted of pediatric patients in intermediate and intensive care units who received parenteral administration of antibiotics, with the exception of newborns, burn unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed.

RESULTS:

A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months). Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134). In 73 (54.4%) of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period.

The 61 (45.5%) remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02); acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04); onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001); and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009).

CONCLUSIONS:

Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.

SciElo

National trends in emergency department antibiotic prescribing for children with acute otitis media, 1996 2005.

National trends in emergency department antibiotic prescribing for children with acute otitis media, 1996 2005.

Acad Emerg Med. 2007 Dec

Fischer T, Singer AJ, Lee C, Thode HC Jr.
Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.

OBJECTIVES: Withholding antibiotics in nontoxic children with acute otitis media (AOM) is now recommended to reduce bacterial resistance rates. Using the National Hospital Ambulatory Medical Care Survey (NHAMCS), the authors describe the national trends for prescribing antibiotics in children with AOM presenting to emergency departments (EDs) in the United States over the past decade. The authors hypothesized that the rates of prescribing antibiotics would decline over time.

METHODS: This was a retrospective study of NHAMCS databases. A national sampling of ED visits for 1996-2005 was used to identify trends in ED prescription of antibiotics to patients with AOM. The National Drug Code Directory Drug Classes were used to identify type of antibiotic prescribed. Frequency and type of antibiotic prescription patterns over time were evaluated.

RESULTS: There were 2.6 million and 2.1 million ED visits for AOM during the first and last years of the study. Children ages 2-12 years accounted for about 40% of all ED visits for AOM, with another 40% in the younger than 2 years age group and 20% in the older than 12 years of age group. During the first and last year of the study, 79.2% and 91.3% of the patients with AOM were prescribed antibiotics, respectively. There was a slight increasing trend in the proportion prescribed antibiotics over time (p = 0.02). The rates of use of antibiotics for AOM were similar in all three age groups.

CONCLUSIONS: There was a slight increase in the percentage of children with AOM who were prescribed antibiotics in the ED between 1996 and 2005. There was also no change in the patterns of prescribing antibiotics.

PMID: 18045893 [PubMed - in process]

Antibiotic prescription and prevalence rate in the outpatient paediatric population: analysis of surveys published during 2000-2005.

Antibiotic prescription and prevalence rate in the outpatient paediatric population: analysis of surveys published during 2000-2005.
Eur J Clin Pharmacol. 2007 Sep 21
Rossignoli A, Clavenna A, Bonati M.
Laboratory for Mother and Child Health, Mario Negri Institute for Pharmacological Research, via G. La Masa 19, 20156, Milan, Italy, clavenna@marionegri.it.

OBJECTIVE: To evaluate antibiotic paediatric consumption data in the community setting using data from studies published between 2000 and 2005 and to compare inter- and intra-country antibiotic prescribing patterns.

METHODS: A literature search was performed in EMBASE and MEDLINE to identify pharmacoepidemiological studies published between 2000 and 2005.

RESULTS: Large differences between studies were found, with significant heterogeneity in epidemiological indicators. Only 20 studies reporting comparable drug prescription data were considered in the analysis, all of which were from the USA, Canada, North-Central Europe and Italy. Pre-school children were reported as comprising the most exposed age group to antibiotic therapy (prevalence 72%; prescription rate 2.2 prescriptions/person per year). In the overall child and adolescent population (less or equal to 19 years), prevalence varied from 14 to 57% (mean 34%), and the prescription rate from 0.2 to 1.3 prescriptions/person per year. Relevant inter-country qualitative and quantitative differences in antibiotic prescribing were apparent, although these were observed in only a few countries: prevalence was higher in Italy and Canada (prevalence range 42-57%) and lower in the Netherlands and the United Kingdom (prevalence range 14-21%). Penicillins were the most prescribed antibiotics in all cases (40-70% of antibiotic prescriptions), followed by macrolides (16-45%), while cephalosporins accounted for a large proportion of the prescriptions in Italy (30-40%) and Canada, but were practically absent in North European prescriptions.

CONCLUSION: Comparative drug utilisation studies on antibiotic use in children are needed, as are improvements in regulatory and educational programmes aimed at limiting the number prescriptions given for antibiotics. Both approaches would address public health problems, such as bacterial resistance and safety and elevated costs, related to the use and misuse of these drugs.

PMID: 17891535 [PubMed - as supplied by publisher]