Public beliefs and use of antibiotics for acute respiratory illness

Impact of COVID-19 on antibiotic usage in primary care: a retrospective analysis

The COVID-19 pandemic has contributed to many changes in the medical practice, including a wider access to tele-consultations. It not only influenced the type of treatment but also shed light on mistakes often made by doctors, such as the abuse of antibiotics. This study aimed to evaluate the antibiotic treatment, and the impact of the COVID-19 pandemic on antibiotic prescribing during a GP's visit. The retrospective medical history analysis involved data from a first-contact medical center (Pantamed, Olsztyn, Poland), from 1 January 2018 to 31 May 2023. Quantities of prescribed antibiotics were assessed and converted into the so-called active list for a given working day of adult patients (> 18 years of age). Statistical analysis based on collective data was performed. During the COVID-19 pandemic, a decline in the number of medical consultations has been observed, both remotely via tele-medicine and in personal appointments, compared to the data from before the pandemic: n = 95,251 versus n = 79,619. Also, during the COVID-19 pandemic, there was a decrease in the total amount of prescribed antibiotics relative to the data before the pandemic (2.44 vs. 4.54; p > 0.001). The decrease in the quantities of prescribed antibiotics did not depend on the way doctor consultations were provided. The COVID-19 pandemic has contributed to changing the family doctors' management of respiratory infections. The ability to identify the etiological agent-the SARS-COV2 virus-contributed to the reduction of the antibiotics use.

Patient Perspectives on the Drivers and Deterrents of Antibiotic Treatment of Acute Rhinosinusitis: a Qualitative Study

BACKGROUND

Antibiotics are prescribed in >80% of outpatient acute rhinosinusitis (ARS) visits, despite the low incidence of bacterial infection. Previous studies have shown patient expectations are the most robust predictor of antibiotics prescription in ARS. However, patient perceptions are not well known or understood.

OBJECTIVE

To understand patient perceptions regarding what drives or deters them from wanting, seeking, and taking antibiotic treatment of ARS.

DESIGN

Iterative thematic analysis of semi-structured interviews.

PARTICIPANTS

Nineteen adults diagnosed with ARS within the prior 60 days at the Northwestern Medicine General Internal Medicine clinic in Chicago, IL.

MAIN MEASURES

Perceptions of patients with ARS.

KEY RESULTS

We interviewed 19 patients, identifying the following drivers of antibiotic use: (1) symptoms, especially discolored rhinorrhea, and seeking relief, (2) belief that antibiotics are a convenient and/or effective way to relieve/cure sinusitis, and (3) desire for tangible outcomes of a clinic visit. For deterrents, the following themes emerged: (1) concern about antibiotic resistance, (2) preference for other treatments or preference to avoid medications, and (3) desire to avoid a healthcare visit. Patients identified that a trustworthy physician's recommendation for antibiotics was a driver, and a recommendation against antibiotics was a deterrent to taking antibiotics; a delayed antibiotic prescription also served as a deterrent. Antibiotic side effects were viewed neutrally by most participants, though they were a deterrent to some.

CONCLUSIONS

Patients have misconceptions about the indications and effectiveness of antibiotics for ARS. Intimate knowledge of key antibiotic drivers and deterrents, from the perspective of patients with ARS, can be leveraged to engage and increase patients' knowledge, and set appropriate expectations for antibiotics for ARS.

The vicious cycle of the public's irrational use of antibiotics for upper respiratory tract infections: A mixed methods systematic review

Background

The public's irrational use of antibiotics for upper respiratory tract infections (URTIs) is prevalent worldwide. This study aims to synthesize evidence on how people use antibiotics to treat URTIs, its prevalence and determinants.

Methods

A mixed methods systematic review was conducted using a convergent segregated approach. Relevant studies were searched from PubMed, Cochrane Library, Embase, and Web of Science. A qualitative analysis was initiated, exploring the public's antibiotic use experience for URTIS based on the Consumer Behavior Model (CBM). This was followed by a quantitative synthesis, tapping into the prevalence and predictors of public behavior in antibiotic usage for URTIs. The segregated syntheses complemented each other and were further integrated.

Results

A total of 86 studies were included: 48 quantitative, 30 qualitative, eight mixed methods studies. The included studies were conducted in Europe (n = 29), Asia (n = 27) and North America (n = 21), assessing the behaviors of patients (n = 46), their parents or caregivers (n = 31), or both (n = 9). Eleven themes emerged covering the six CBM stages: need recognition, information searching, alternative evaluation, antibiotic obtaining, antibiotic consumption, and post-consumption evaluation. The six stages reinforce each other, forming a vicious cycle. The high prevalence of the public's irrational use of antibiotics for URTIs is evident despite the high heterogeneity of the studies (ranging from 0.0 to 92.7%). The perceived seriousness of illness and misbelief in antibiotics were identified consistently across the studies as the major motivation driving the public's irrational use of antibiotics for URTIs. However, individual capacity (e.g., knowledge) and opportunity (e.g., contextual restriction) in reducing antibiotic use have mixed effect.

Conclusion

Systemic interventions concerning both supply and demand sides are warranted. The public needs to be educated about the appropriate management of URTIs and health care providers need to re-shape public attitudes toward antibiotic use for URTIs through communication and prescribing practices.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier: CRD42021266407.

Qinbaohong Zhike Oral Liquid Attenuates LPS-Induced Acute Lung Injury in Immature Rats by Inhibiting OLFM4

Acute respiratory infections (ARIs) are a common public safety threat with high morbidity and mortality in pediatric patients worldwide. Qinbaohong Zhike oral liquid (QBH), a marketed traditional Chinese medicine product, has been widely used to cure respiratory diseases. QBH is reported to have antitussive, expectorant, and antiasthmatic properties. However, its treatment effect against ARIs is not elucidated. This study aimed to explore the therapeutic efficacy of QBH in the treatment of ARIs-induced pneumonia. Network pharmacology was used to predict the possible targets of QBH against ARIs. Next, the tracheal lipopolysaccharide (LPS-)-induced acute lung injury (ALI) immature rat model was constructed to evaluate the therapeutic effect of QBH. Tandem mass tag (TMT-)-based quantitative proteomics was then used to screen the in-depth disease targets of QBH. QBH exerted a protective effect against LPS-induced ALI by inhibiting pulmonary pathological damage. QBH also reduced the levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and granulocyte macrophage colony-stimulating factor (GM-CSF) in the serum and IL-1β, IL-6, IL-8, TNF-α, IFN-γ, and GM-CSF in the lung tissue. Based on proteomic data, olfactomedin 4 (OLFM4) related to immunity and inflammation was selected as a potential target. Western blot analysis further confirmed the moderating effect of QBH downregulation on OLFM4 in the lung tissue. Our findings demonstrated that QBH alleviated lung tissue damage and inflammatory reaction via inhibiting OLFM4 expression in LPS-challenged immature rats. Our research indicates that QBH may have therapeutic potential for treating ARIs-related ALI in pediatric patients, which also serves as a candidate target for drug therapy of ALI by intervening OLFM-related signaling pathways.

A multicentric knowledge-attitude-practice survey in the community about antimicrobial use and resistance in India

BACKGROUND

To address the reasons for inappropriate use of antimicrobials, it is important to understand the knowledge, attitude and practices (KAP) of all pertinent stakeholders. This multicentric survey is aimed at understanding the KAP quotients of the community regarding antimicrobial use and antimicrobial resistance (AMR), as such information is lacking in India.

METHODS

A cross-sectional survey was conducted by face-to-face interviews across five centers in India using a validated, field-tested questionnaire incorporating KAP domain questions. Scores were appropriately assigned to the questions.

RESULTS

The mean (SD) age of the respondents was 35.2 (12.61) y and 62% had a graduate or higher level of education. The median (IQR) KAP scores were 10 (8-12), 5 (3-5) and 2 (2-3) out of a maximum of 18, 5 and 6, respectively. Higher educational and socioeconomic levels were associated with better attitude scores, but knowledge levels were comparable. Correlations between KAP scores were poor.

CONCLUSIONS

This study reveals that laypeople have appropriate knowledge and attitude regarding antibiotic use and AMR to some degree but there are important lacunae and practices are often wanting. These issues need to be addressed in sustained public awareness and motivation campaigns to improve the rational use of antibiotics in India.

A scoping review on the influential cognitive constructs informing public AMR behavior compliance and the attribution of personal responsibility

BACKGROUND

Antibiotic resistance is a growing threat to public health. Despite various attempts at educating the public on antimicrobial resistance (AMR) and judicial antibiotic use, fallacies and misconceptions remain. To successfully promote behavior change, various cognitive constructs pertaining to antibiotic behavior need to be identified and targeted.

METHODS

Using the Arksey and O'Malley (2005) methodological framework, a credible reflexive examination of literature was conducted, permitting identification of a breadth of literature that pertained to the influence of cognitive constructs on public antimicrobial behavior.

RESULTS

From 393 abstracts identified, 67 full articles were screened, and 43 papers were chosen for review. Three themes were identified (1) sociodemographic influences; (2) knowledge, misconceptions, and fallacies; and (3) public attitudes and the social influence of friends and family. Geographical location, education level, cognitive dissonance, and social norms were found to influence AMR cognition, resulting in disproportionate risk assessments that are facilitated by social information brokering.

CONCLUSIONS

Public AMR resilience, responsibility, and behavior compliance are influenced by cognitive constructs, which are liable to the appropriation of misconceptions, fallacies, and social behavior models obtained via information brokering. A cohesive multidisciplinary participatory approach to AMR management and interventional design that applies the influence of cognitive constructs to inform public AMR behavior compliance is recommended.

Patient expectation trends on receiving antibiotic prescriptions for respiratory tract infections: A systematic review and meta-regression analysis

BACKGROUND

Despite a variety of programs developed to control inappropriate antibiotic prescribing for viral infections, antibiotics are still prescribed excessively for Respiratory Tract Infections (RTI). The patient's expectation to receive an antibiotic often influences the clinician's decision and can lead to inappropriate antibiotic prescriptions. Our objective was to investigate the changes in patient expectations over time when presenting with symptoms of a respiratory infection.

METHODS

We performed a systematic review of patient's expectation to receive antibiotics for RTIs. Two reviewers independently evaluated the collected studies based on inclusion and exclusion criteria. Our search initially identified 12 070 studies, of which 321 studies were eligible for full text review and 37 articles were selected for final evaluation. Meta-regression analysis was used to evaluate the association between patient expectations and different years. Heterogeneity was evaluated using the Q statistic.

RESULTS

Patient expectations (effect size) were pooled using a random effects model. The effect-equality test showed heterogeneity among studies (Q = 3304.23, df = 40, P < 0.0001, k = 40, τ²  = 0.63). Meta-regression results revealed that there is a significant linear negative relationship (B = -1.8374, P < 0.05) between patient expectation and year of data collection, at the global level. A similar finding is observed for the subset of studies conducted outside United States (U.S.) (B = -1.2411, P < 0.1). However, there is no discernible trend for patient expectation in the U.S. or among children and adult subgroups. Also, no significant differences are observed between the patient expectations when considering different age groups.

CONCLUSION

The trend of patient expectation for receiving antibiotics for RTIs is declining over time on a global level and also outside the U.S.

Patient Willingness to Have Tests to Guide Antibiotic Use for Respiratory Tract Infections: From the WWAMI Region Practice and Research Network (WPRN)

INTRODUCTION

The majority of consultations for acute respiratory tract infections (RTIs) lead to prescriptions for antibiotics, which have limited clinical benefit. We explored patients' willingness to have blood tests as part of the diagnostic work-up for RTIs, and patient knowledge about antibiotics.

METHODS

Patients at 6 family medicine clinics were surveyed. Regression modeling was used to determine independent predictors of willingness to have venous and point-of-care (POC) blood tests, and knowledge of the value of antibiotics for RTIs.

RESULTS

Data were collected from 737 respondents (response rate 83.8%), of whom 65.7% were women, 60.1% were white, and 25.1% were current smokers; patients' mean age was 46.9 years. Sex (female), race (white), and a preference to avoid antibiotics were independent predictors of greater level of antibiotic knowledge. A total of 63.1% were willing to have a venous draw and 79% a POC blood test, to help guide antibiotic decision-making. Non-American Indian/Alaskan Native race, current smoking, and greater knowledge of antibiotics were independent predictors of willingness to have a POC test.

CONCLUSION

A large majority of patients seemed willing to have POC tests to facilitate antibiotic prescribing decisions for RTIs. Poor knowledge about antibiotics suggests better education regarding antibiotic use might influence patient attitudes towards use of antibiotics for RTIs.

Surveys of public knowledge and attitudes with regard to antibiotics in Poland: Did the European Antibiotic Awareness Day campaigns change attitudes?

BACKGROUND

Antimicrobial resistance is a global public health problem. Monitoring the level of knowledge regarding antibiotics is a part of the European Union Community strategy against antimicrobial resistance.

OBJECTIVE

To assess knowledge by the general public in Poland regarding antibiotics, AMR, and the impact of the European Antibiotic Awareness Day campaigns.

METHODS

The repeated cross-sectional study was developed and carried out among the general public in Poland (in 5 waves between 2009 and 2011, embracing a total of 5004 respondents). The survey was based on a self-designed questionnaire, and carried out by Millward Brown SMG/KRC, using Computer Assisted Telephone Interviews (CATI).

RESULTS

A high percentage of Polish adults had used antibiotics within the 12 months preceding their participation in the study (38%). Statistically relevant differences were observed regarding the respondents' gender, age, education and employment status. The majority of the antibiotics used were prescribed by physicians (90%). In all five waves, 3% of the respondents purchased an antibiotic without a prescription. Prescriptions were mostly obtained from a general practitioner. The prevailing reasons for taking antibiotics were the common cold, sore throat, cough and flu. Approximately 40% of the respondents expected a prescription for an antibiotic against the flu. The vast majority knew that antibiotics kill bacteria (80%) but at the same time 60% of respondents believed antibiotics kill viruses. Physicians, pharmacists, hospital staff and nurses were mentioned as the most trustworthy sources of information. A third of the respondents declared to have come across information on the prudent use of antibiotics in the preceding 12 months. In the fifth wave, nearly half of the participants (48%), who had come across information about antibiotics in the preceding 12 months declared that the information resulted in a change in their attitude towards antibiotic use.

CONCLUSION

The survey generated information about the knowledge, attitude, and behavior regarding antibiotics among the general population of Poland. Inappropriate antibiotic use is still highly prevalent in Poland, although a positive trend in behavioral change was observed after the educational campaigns. Additional didactic and systematic education campaigns regarding appropriate antibiotic use are needed and the use of the Internet as an education tool should be enhanced.

Pharmacists’ Perceptions Regarding Optimization of Antibiotic Prescribing in the Community

Background and Objective:

The overuse of antibiotics in the community is a primary cause of antibiotic resistance. Community pharmacists are the most accessible health professionals and so they are in an ideal position to implement interventions to ensure the appropriate use of antibiotics. This study aimed to explore the role of community pharmacists in the optimization of antibiotic prescribing and utilization.

Method:

Four focus groups were conducted with community pharmacists in Perth, Western Australia. Audio-recorded data were compared with field notes, transcribed, and thematically analyzed.

Results:

There were twenty-four participants in four focus group sessions. Four main themes were identified: patient perceptions and behaviors, prescribing behaviors, pharmacists’ roles and responsibilities, and health care system interventions in relation to antibiotic utilization. A number of interventions that could be implemented by community pharmacists were identified. In addition to interventions that are currently in place in Australia, forward dispensing, improved interprofessional collaboration, an expansion of current prescribing role, and vaccination capabilities were also suggested.

Conclusions:

This study indicated that current scope of pharmacists’ roles has room for more intervention strategies aimed at improving antibiotic prescribing and utilization in the community.

Role of Atypical Pathogens and the Antibiotic Prescription Pattern in Acute Bronchitis: A Multicenter Study in Korea

The role of atypical bacteria and the effect of antibiotic treatments in acute bronchitis are still not clear. This study was conducted at 22 hospitals (17 primary care clinics and 5 university hospitals) in Korea. Outpatients (aged ≥ 18 yr) who had an acute illness with a new cough and sputum (≤ 30 days) were enrolled in 2013. Multiplex real-time polymerase chain reaction (RT-PCR) was used to detect five atypical bacteria. A total of 435 patients were diagnosed as having acute bronchitis (vs. probable pneumonia, n = 75), and 1.8% (n = 8) were positive for atypical pathogens (Bordetella pertussis, n = 3; B. parapertussis, n = 0; Mycoplasma pneumoniae, n = 1; Chlamydophila pneumoniae, n = 3; Legionella pneumophila, n = 1). Among clinical symptoms and signs, only post-tussive vomiting was more frequent in patients with atypical pathogens than those without (P = 0.024). In all, 72.2% of the enrolled patients received antibiotic treatment at their first visits, and β-lactams (29.4%) and quinolones (20.5%) were the most commonly prescribed agents. In conclusion, our study demonstrates that the incidence of atypical pathogens is low in patients with acute bronchitis, and the rate of antibiotic prescriptions is high.

Antibiotic use and resistance: a cross-sectional study exploring knowledge and attitudes among school and institution personnel in Tbilisi, Republic of Georgia

Background

The Republic of Georgia lacks regulations regarding drug prescriptions. In pharmacies, all drugs except psychotropic medication are sold legally without prescription anti-, including anti-tuberculosis agents. Due to the lack of adequate policies and regulations, the big share of responsibility regarding antibiotic education lies with the general public. This study examines public knowledge and attitudes toward antibiotic use and resistance in the Republic of Georgia among personnel from government schools and other public institutions.

Methods

This cross-sectional study was conducted in June 2011 using a quantitative questionnaire. Convenience sampling method was used. Participants included 250 individuals aged 21–80 years, from government schools and public institutions. Participants were from Tbilisi as well as the surrounding rural and urban areas. Respondents provided demographic data along with statements on knowledge and attitudes towards antibiotic use and resistance. Poisson and logistic regression models were used to study the relationship between knowledge, attitude outcomes and socio-demographic characteristics.

Results

The overall response rate was 75 % (n = 187), of which 80 % were female. Approximately 91 % of respondents had used antibiotics at least once and 55 % agreed that antibiotics speed up recovery from common colds. A number of respondents (55 %) reported having received antibiotics without previously consulting a doctor and 62 % reported having purchased antibiotics without a prescription. Respondents demonstrated some misunderstanding around the terms ‘bacteria’ and ‘virus.’ About 52 % of participants agreed that antibiotics are effective against bacteria; however, 55 % also agreed that antibiotics are effective against viruses. Trust in doctors was high at 80 %. More knowledge was associated with a lower probability of having purchased antibiotics without medical consultation.

Conclusions

The study findings demonstrate that respondents have several misconceptions and lack knowledge on proper antibiotic use and resistance. High proportion of people use antibiotics without a medical prescription or consultation, while having high trust in the medical personnel. We believe that the high level of trust in doctors shown by our respondents should be acknowledged by the Georgian government, health care providers and public health policy professionals. Furthermore, the information should be utilized in future educational and antibiotic resistance awareness raising campaigns.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-015-1477-1) contains supplementary material, which is available to authorized users.

Prevalence of Parental Misconceptions About Antibiotic Use

BACKGROUND

Differences in antibiotic knowledge and attitudes between parents of Medicaid-insured and commercially insured children have been previously reported. It is unknown whether understanding has improved and whether previously identified differences persist.

METHODS

A total of 1500 Massachusetts parents with a child <6 years old insured by a Medicaid managed care or commercial health plan were surveyed in spring 2013. We examined antibiotic-related knowledge and attitudes by using χ(2) tests. Multivariable modeling was used to assess current sociodemographic predictors of knowledge and evaluate changes in predictors from a similar survey in 2000.

RESULTS

Medicaid-insured parents in 2013 (n = 345) were younger, were less likely to be white, and had less education than those commercially insured (n = 353), P < .01. Fewer Medicaid-insured parents answered questions correctly except for one related to bronchitis, for which there was no difference (15% Medicaid vs 16% commercial, P < .66). More parents understood that green nasal discharge did not require antibiotics in 2013 compared with 2000, but this increase was smaller among Medicaid-insured (32% vs 22% P = .02) than commercially insured (49% vs 23%, P < .01) parents. Medicaid-insured parents were more likely to request unnecessary antibiotics in 2013 (P < .01). Multivariable models for predictors of knowledge or attitudes demonstrated complex relationships between insurance status and sociodemographic variables.

CONCLUSIONS

Misconceptions about antibiotic use persist and continue to be more prevalent among parents of Medicaid-insured children. Improvement in understanding has been more pronounced in more advantaged populations. Tailored efforts for socioeconomically disadvantaged populations remain warranted to decrease parental drivers of unnecessary antibiotic prescribing.

Public beliefs on antibiotics and symptoms of respiratory tract infections among rural and urban population in Poland: a questionnaire study

Introduction

General public views and expectations around the use of antibiotics can influence general practitioners' antibiotic prescribing decisions. We set out to describe the knowledge, attitudes and beliefs about the use of antibiotics for respiratory tract infections in adults in Poland, and explore differences according to where people live in an urban-rural continuum.

Material and Methods

Face to face survey among a stratified random sample of adults from the general population.

Results

1,210 adults completed the questionnaire (87% response rate); 44.3% were rural; 57.9% were women. 49.4% of rural respondents and 44.4% of urban respondents had used an antibiotic in the last 2 years. Rural participants were less likely to agree with the statement “usually I know when I need an antibiotic,” (53.5% vs. 61.3% respectively; p = 0.015) and reported that they would consult with a physician for a cough with yellow/green phlegm (69.2% vs. 74.9% respectively; p = 0.004), and were more likely to state that they would leave the decision about antibiotic prescribing to their doctor (87.5% vs. 85.6% respectively; p = 0.026). However, rural participants were more likely to believe that antibiotics accelerate recovery from sore throat (45.7% vs. 37.1% respectively; p = 0.017). Use of antibiotic in the last 2 years, level of education, number of children and awareness of the problem of developing antimicrobial resistance predicted accurate knowledge about antibiotic effectiveness.

Conclusions

There were no major differences in beliefs about antibiotics between urban and rural responders, although rural responders were slightly less confident in their knowledge about antibiotics and self-reported greater use of antibiotics. Despite differences in the level of education between rural and urban responders, there were no significant differences in their knowledge about antibiotic effectiveness.

Public Beliefs about Antibiotics, Infection and Resistance: A Qualitative Study

We aimed to gain an in-depth understanding of public views and ways of talking about antibiotics. Four focus groups were held with members of the public. In addition, 39 households were recruited and interviews, diaries of medicine taking, diaries of any contact with medication were used to explore understanding and use of medication. Discussions related to antibiotics were identified and analyzed. Participants in this study were worried about adverse effects of antibiotics, particularly for recurrent infections. Some were concerned that antibiotics upset the body’s “balance”, and many used strategies to try to prevent and treat infections without antibiotics. They rarely used military metaphors about infection (e.g., describing bacteria as invading armies) but instead spoke of clearing infections. They had little understanding of the concept of antibiotic resistance but they thought that over-using antibiotics was unwise because it would reduce their future effectiveness. Previous studies tend to focus on problems such as lack of knowledge, or belief in the curative powers of antibiotics for viral illness, and neglect the concerns that people have about antibiotics, and the fact that many people try to avoid them. We suggest that these concerns about antibiotics form a resource for educating patients, for health promotion and social marketing strategies.

Enabling factors for antibiotic prescribing for upper respiratory tract infections: perspectives of Lithuanian and Russian general practitioners

INTRODUCTION

General practitioners (GPs) write about 80% of all antibiotic prescriptions, the greatest number of them for patients with respiratory tract infections. However, there is a lack of research targeting the influence of external factors on antibiotic prescribing by physicians. This study aimed to explore experiences of GPs in Lithuania and the Russian Federation with regard to antibiotic prescription for upper respiratory tract infections. By such means it might be possible to reveal external enabling factors that influence antibiotic prescribing in these countries.

METHOD

Five focus groups were performed with 22 GPs from Lithuania and 29 GPs from the Kaliningrad Region of the Russian Federation; then, thematic analysis of data was performed.

RESULTS

Six thematic categories were identified that are related to external forces enabling antibiotic prescription: the necessity for political leadership to encourage clinically grounded antibiotic use; over-the-counter sale of antibiotics; designation of antibiotics as reimbursable medications; supervision by external oversight institutions; lack of guidelines for the treatment of upper respiratory tract infections; and pharmaceutical company activities.

CONCLUSIONS

Comprehensive efforts to reduce the burden of non-clinically grounded antibiotic prescription should go beyond addressing factors at the physician-patient level and take into account important factors in the enabling environment as well.

Variations in antibiotic prescribing of acute rhinosinusitis in United States ambulatory settings

OBJECTIVE

To identify variations in antibiotic treatment of acute rhinosinusitis (ARS) on a national level.

STUDY DESIGN

Cross-sectional study of a national database.

SETTING

Otolaryngology and primary care ambulatory settings.

SUBJECTS AND METHODS

A nationally representative sample of adult outpatient visits was extracted from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey data for 2006 to 2009. Antibiotic prescriptions associated with ARS were tabulated. Statistical analyses were conducted to identify variations in antibiotic prescribing by patient and physician characteristics.

RESULTS

Antibiotics were prescribed in 82.3% ± 2.6% of 18.7 million visits for ARS (mean age, 46.2 years; 65.9% female). The ratio of primary care physician (PCP) to otolaryngologist (ENT) ARS visits was 18.6:1. Antibiotic prescription rates were inversely related to increasing age groups of 18 to 39, 40 to 64, and ≥ 65 years (87.8%, 81.2%, and 71.0%, respectively; P = .02). Physicians in general medicine outpatient departments, internal medicine, and family medicine were more likely to prescribe antibiotics compared with ENTs (adjusted odds ratio [OR], 7.9 [95% confidence interval (CI), 3.5-17.8]; 6.9 [2.5-19.2]; and 3.9 [2.0-7.7], respectively). The most commonly prescribed antibiotics were azithromycin, amoxicillin, and amoxicillin/clavulanate acid (27.5%, 15.5%, and 14.6%, respectively). The ENTs selected broad-spectrum antibiotics more often than PCPs (94.3% vs 75.7% of visits with antibiotics were broad-spectrum agents; P = .01).

CONCLUSION

Antibiotics were prescribed frequently despite recent consensus guidelines that discourage antibiotic use in mild cases. Furthermore, antibiotic prescription was more likely for younger patients and in primary care settings. This highlights the need to promote awareness of practice guidelines.

How long does a cough last? Comparing patients' expectations with data from a systematic review of the literature

PURPOSE

We hypothesized that antibiotic overuse for acute cough illness (ACI) is in part due to a mismatch between patients' expectations and the natural history of ACI.

METHODS

We performed a population-based random digit dialing survey of 493 adults in Georgia to determine their expectations regarding the duration of ACI. We also performed a systematic review of observational studies and the placebo or untreated control groups of randomized controlled trials to determine the duration of ACI from the published medical literature. We included studies of otherwise healthy adults with undifferentiated ACI, no clear bacterial cause, data on at least 1 cough outcome, and at least 1 week of follow-up.

RESULTS

The mean duration of cough in the published literature was 17.8 days. Survey respondents reported a median duration of 5 to 7 days and a mean duration of 7.2 to 9.3 days depending on the specific scenario. Patients expecting a longer duration of illness were more likely to be white, female, and have self-reported asthma or chronic lung disease. Independent predictors of the belief that antibiotics are always helpful included nonwhite race (OR = 1.82, 95% CI, 1.14-2.92), some college education or less (OR = 2.08, 95% CI, 1.26-3.45), and previous antibiotics for ACI (OR = 2.20, 95% CI, 1.34-3.55).

CONCLUSIONS

There is a mismatch between patients' expectations regarding the duration of ACI and the actual duration based on the best available evidence. Efforts to reduce inappropriate antibiotic use should target this discrepancy.

Validity and reliability of instruments designed to measure factors influencing the overuse of antibiotics

BACKGROUND

Antibiotic overuse is a global public health issue that is influenced by several factors. The degree and prevalence of antibiotic overuse is difficult to measure directly. A more practical approach, such as the use of a psycho-social measurement instrument, might allow for the observation and assessment of patterns of antibiotic use.

STUDY OBJECTIVE

The aim of this paper is to review the nature, validity, and reliability of measurement scales designed to measure factors associated with antibiotic misuse/overuse.

DESIGN

This study is descriptive and includes a systematic integration of the measurement scales used in the literature to measure factors associated with antibiotic misuse/overuse. The review included 70 international scientific publications from 1992 to 2010.

MAIN RESULTS

Studies have presented scales to measure antibiotic misuse. However, the workup of these instruments is often not mentioned, or the scales are used with only early-phase validation, such as content or face validity. Other studies have discussed the reliability of these scales. However, the full validation process has not been discussed in any of the reviewed measurement scales.

CONCLUSION

A reliable, fully validated measurement scale must be developed to assess the factors associated with the overuse of antibiotics. Identifying these factors will help to minimize the misuse of antibiotics.

Optimizing knowledge of antiviral medications for prophylaxis and treatment of influenza during pregnancy

Pregnant women are particularly susceptible to influenza-related morbidity and mortality and have historically been over-represented among patients with influenza, requiring hospitalization and intensive care unit admission. This has been observed during both nonpandemic and pandemic influenza seasons. During the H1N1 influenza pandemic of 2009-2010, pregnant women again had an increased likelihood of hospital or intensive care unit admission, and many deaths were documented. One identified risk factor for more severe disease was a delay in the initiation of antiviral medications. Vaccination is currently the most effective method for preventing severe influenza and its sequelae, and antiviral medications are used as an important adjunct to vaccination. Knowledge among pregnant women regarding influenza vaccine recommendations is poor, but by improving knowledge and understanding, vaccine rates can be increased. Although there are no published data examining knowledge regarding antiviral medications, one can hypothesize that knowledge is similarly low. In the current era, the appropriate use of vaccination and antiviral medications is the best defense against complications of influenza among pregnant women, and optimizing knowledge about these strategies among providers and patients alike is of paramount importance.

A computerized education module improves patient knowledge and attitudes about appropriate antibiotic use for acute respiratory tract infections

BACKGROUND

Over-use of antibiotics for acute respiratory infections (ARIs) increases antimicrobial resistance, treatment costs, and side effects. Patient desire for antibiotics contributes to over-use.

OBJECTIVE

To explore whether a point-of-care interactive computerized education module increases patient knowledge and decreases desire for antibiotics.

METHODS

Bilingual (English/Spanish) interactive kiosks were available in 8 emergency departments as part of a multidimensional intervention to reduce antibiotic prescribing for ARIs. The symptom-tailored module included assessment of symptoms, knowledge about ARIs (3 items), and desire for antibiotics on a 10-point visual analog scale. Multivariable analysis assessed predictors of change in desire for antibiotics.

RESULTS

Of 686 adults with ARI symptoms, 63% initially thought antibiotics might help. The proportion of patients with low (1-3 on the scale) desire for antibiotics increased from 22% pre-module to 49% post-module (p<.001). Self-report of "learning something new" was associated with decreased desire for antibiotics, after adjusting for baseline characteristics (p=.001).

CONCLUSION

An interactive educational kiosk improved knowledge about antibiotics and ARIs. Learning correlated with changes in personal desire for antibiotics.

PRACTICE IMPLICATIONS

By reducing desire for antibiotics, point-of-care interactive educational computer technology may help decrease inappropriate use for antibiotics for ARIs.

Infectious disease management in primary care: perceptions of GPs

Background

It is important to keep the level of antibiotic prescribing low to contain the development of resistant bacteria. This study was conducted to reveal new knowledge about how GPs think in relation to the prescribing of antibiotics - knowledge that could be used in efforts toward rational treatment of infectious diseases in primary care. The aim was to explore and describe the variations in GPs' perceptions of infectious disease management, with special reference to antibiotic prescribing.

Methods

Twenty GPs working at primary care centres in a county in south-west Sweden were purposively selected based on the strategy of including GPs with different kinds of experience. The GPs were interviewed and perceptions among GPs were analysed by a phenomenographic approach.

Results

Five qualitatively different perceptions of infectious disease management were identified. They were: (A) the GP must help the patient to achieve health and well-being; (B) the management must meet the GP's perceived personal, professional and organisational demands; (C) restrictive antibiotic prescribing is time-consuming; (D) restrictive antibiotic prescribing can protect the effectiveness of antibiotics; and (E) patients benefit personally from restrictive antibiotic prescribing.

Conclusions

Restrictive antibiotic prescribing was considered important in two perceptions, was not an issue as such in two others, and was considered in one perception although the actual prescribing was greatly influenced by the interaction between patient and GP. Accordingly, to encourage restrictive antibiotic prescribing several aspects must be addressed. Furthermore, different GPs need various kinds of support. Infectious disease management in primary care is complex and time-consuming, which must be acknowledged in healthcare organisation and planning.

Upper respiratory infections

It is estimated that >24 million cases of acute bacterial sinusitis occur annually in the United States. Recently, a number of medical societies have issued guidelines to aid in the management of upper respiratory tract infections (URIs). Although these guidelines serve to aid practitioners in the proper use of antibiotics, confusion remains regarding the disparity of guideline recommendations as well as some recommendations being outdated. This review presents 3 illustrative case studies designed to provide some clarity with regard to these guidelines. Case 1 is a typical presentation of a patient with worsening sinus conditions over the previous 2 weeks. Case 2 is a more challenging case of a patient with a sinus condition accompanied by a penicillin allergy that ultimately requires referral to an otolaryngologist. Case 3 is an atypical case with symptoms of a sinus infection accompanied by a normal sinus computed tomography scan. It is hoped that the presentation and discussion surrounding these cases will provide some helpful insights into the management of patients with URIs.

A survey of public knowledge and awareness related to antibiotic use and resistance in Sweden

OBJECTIVES

To examine the level of knowledge about antibiotic treatment and awareness of antibiotic resistance among the general public in Sweden.

METHODS

A quantitative, cross-sectional interview study based on a structured questionnaire used during telephone interviews. The sample comprised 1000 randomly selected individuals aged 21-80 years throughout Sweden. Demographic data as well as level of agreement with various statements concerning antibiotics and antibiotic use were provided by the respondents.

RESULTS

The response rate was 74.7%. Of the respondents, 19.1% agreed that antibiotics cure common colds more quickly; this belief was higher in those who had not previously received antibiotics. A high proportion, 80.7%, agreed that bacteria could become resistant to antibiotics. Trust in doctors was high, and significantly more respondents reported trusting the doctor not prescribing an antibiotic, 87.0%, than the doctor prescribing an antibiotic, 81.0%. The respondents showed some confusion surrounding the terms 'bacteria' and 'viruses', and the meaning of these in relation to the prescribing decision.

CONCLUSIONS

The high level of trust in restrictive prescribing as well as the awareness of antibiotic resistance expressed by the Swedish public should be recognized by health professionals and utilized in future campaigns.

Self-medication with antibiotics: questionnaire survey among primary care center attendants

PURPOSE

The aim of this study was to determine the frequency and reasons for self-medication with antibiotics within the last 12 months among primary healthcare center attendants aged 18 or over, in Ankara.

METHODS

A questionnaire was applied by face to face interview technique to 2696 subjects attending at five primary healthcare centers. Information on demographic characteristics, intention to self-medication with antibiotics and self-medication within last 12 months were collected.

RESULTS

It was found that 28% of the subjects were storing antibiotics at home. The percentage of self-administering antibiotics was 19.1% in the last 12 months. The most common reasons for self-administration of antibiotics were sore throat (59.6%), fever (46.2%), and cough (40.0%). Other reasons were dental infection, rheumatism, and fatigue. According to age groups, the most common self-medicating group was those aged 40-49 with 23% while the least self-usage was in the 60-69 age groups with 11.8%. Male sex, being single, educational level of secondary school or higher, being employed and not having social security increased self-administration of antibiotics (p < 0.05).

CONCLUSIONS

The study indicated the need for legal regulations regarding the sale of antibiotics without prescription and, health education is required for the community to decrease the inappropriate use of antibiotics and self-medication.

Emergency department visits for antibiotic-associated adverse events

BACKGROUND

Drug-related adverse events are an under-appreciated consequence of antibiotic use, and the national magnitude and scope of these events have not been studied. Our objective was to estimate and compare the numbers and rates of emergency department (ED) visits for drug-related adverse events associated with systemic antibiotics in the United States by drug class, individual drug, and event type.

METHODS

We analyzed drug-related adverse events from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project (2004-2006) and outpatient prescriptions from national sample surveys of ambulatory care practices, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (2004-2005).

RESULTS

On the basis of 6614 cases, an estimated 142,505 visits (95% confidence interval [CI], 116,506-168,504 visits) annually were made to US EDs for drug-related adverse events attributable to systemic antibiotics. Antibiotics were implicated in 19.3% of all ED visits for drug-related adverse events. Most ED visits for antibiotic-associated adverse events were for allergic reactions (78.7% of visits; 95% CI, 75.3%-82.1% of visits). One-half of the estimated ED visits were attributable to penicillins (36.9% of visits; 95% CI, 34.7%-39.2% of visits) and cephalosporins (12.2%; 95% CI, 10.9%-13.5%). Among commonly prescribed antibiotics, sulfonamides and clindamycin were associated with the highest rate of ED visits (18.9 ED visits per 10,000 outpatient prescription visits [95% CI, 13.1-24.7 ED visits per 10,000 outpatient prescription visits] and 18.5 ED visits per 10,000 outpatient prescription visits [95% CI, 12.1-25.0 ED visits per 10,000 outpatient prescription visits], respectively). Compared with all other antibiotic classes, sulfonamides were associated with a significantly higher rate of moderate-to-severe allergic reactions (4.3% [95% CI, 2.9%-5.8%] vs. 1.9 % [95% CI, 1.5%-2.3%]), and sulfonamides and fluoroquinolones were associated with a significantly higher rate of neurologic or psychiatric disturbances (1.4% [95% CI, 1.0%-1.7%] vs. 0.5% [95% CI, 0.4%-0.6%]).

CONCLUSIONS

Antibiotic-associated adverse events lead to many ED visits, and allergic reactions are the most common events. Minimizing unnecessary antibiotic use by even a small percentage could significantly reduce the immediate and direct risks of drug-related adverse events in individual patients.

Public beliefs on antibiotics and respiratory tract infections: an internet-based questionnaire study

BACKGROUND

Patient expectations are among the strongest predictors of clinicians' antibiotic prescribing decisions. Although public knowledge, beliefs, and experiences of antibiotics contribute to these expectations, little is known about these public views.

AIM

To gain insight into public knowledge, beliefs, and experiences of antibiotics and respiratory tract infections.

DESIGN OF STUDY

Cross-sectional, internet-based questionnaire study.

SETTING

Members of the general public aged 16 years and over in the Netherlands.

METHODS

Public knowledge, beliefs, and experiences of antibiotics and respiratory tract infections, as well as predictors of accurate knowledge of antibiotic effectiveness, were measured using 20 questions with sub-items. The questionnaire was given to a Dutch community-based nationwide internet panel of 15 673 individuals. Of these, 1248 eligible responders were invited to participate; 935 responders (75%) completed the questionnaire.

RESULTS

Of the participants, 44.6% accurately identified antibiotics as being effective against bacteria and not viruses. Acute bronchitis was considered to require treatment with antibiotics by nearly 60% of responders. The perceived need for antibiotics for respiratory tract infection-related symptoms ranged from 6.5% for cough with transparent phlegm, to 46.2% for a cough lasting for more than 2 weeks.

CONCLUSION

Public misconceptions on the effectiveness of, and indications for, antibiotics exist. Nearly half of all responders (47.8%) incorrectly identified antibiotics as being effective in treating viral infections. Doctors should be aware that unnecessary prescribing could facilitate misconceptions regarding antibiotics and respiratory tract infections. Expectations of receiving antibiotics were higher for the disease label 'acute bronchitis' than for any of the separate or combined symptoms prominently present in respiratory tract infection. Public beliefs and expectations should be taken into account when developing interventions targeting the public, patients, and physicians to reduce unnecessary prescribing of antibiotics for respiratory tract infections.

Patient knowledge and attitudes about avian influenza in an internal medicine clinic

BACKGROUND

Avian influenza is an emerging threat to public health, but little is known about how the public perceives this threat. The objective of this study was to describe beliefs, attitudes and knowledge regarding avian influenza among patients in an internal medicine clinic.

STUDY DESIGN

Cross-sectional survey.

METHODS

Four hundred adult patients in an internal medicine clinic received the survey between April and June 2006.

RESULTS

The most common sources of information about avian influenza were local and national television news (74%), cable news (51%) and newspapers (50%). The mean percentage of correct answers to seven questions regarding knowledge of avian influenza was 49%. Multivariable linear regression using the percentage of correct answers to these questions as the primary outcome showed that: (1) college education, Internet and cable news as sources; (2) income greater than $75,000; and (3) receiving an influenza vaccine in the last influenza season were positively associated with knowledge. Having a viral upper respiratory infection on the day of the survey was negatively associated with knowledge. However, greater knowledge was not associated with more positive attitudes regarding possible public health interventions in a pandemic setting. Although 42% of patients were worried about avian influenza, only 22% trusted the Government to contain its spread. Most patients were willing to wear a mask (82%), be quarantined (78%) or undergo mandatory vaccination (55%).

CONCLUSION

Knowledge about avian influenza was poor in this mainly college-educated sample, but most patients had positive attitudes towards public health control measures that would be used in a pandemic scenario. Further studies are needed to inform education strategies and pandemic influenza planning.

Patient knowledge and attitudes about antiviral medication and vaccination for influenza in an internal medicine clinic

BACKGROUND

Despite the introduction of Centers for Disease Control and Prevention guidelines for their use, antiviral medications for influenza remain underutilized. Our objective in this study was to describe beliefs, attitudes, and knowledge regarding antiviral medication and vaccination for influenza among patients in an internal medicine clinic.

METHODS

We conducted a cross-sectional survey of adult patients in an internal medicine clinic from April through June 2006.

RESULTS

Two-hundred eighty patients completed the survey. Fifty-five percent received influenza vaccination for the most recent influenza season. Overall antiviral knowledge was poor. Of 8 antiviral knowledge questions, the mean percentage of correct answers was 40%; 1 (<1%) of the patients answered all questions correctly, and 47 (18%) answered all questions incorrectly. Only 37 (13%) of the patients reported calling their physician within 48 h after the onset of influenza-like symptoms. Patients with conditions associated with a high risk of complications from influenza were no more likely than other patients to be more knowledgeable about antiviral medication, nor were they more likely to report calling their physician within 48 h after symptom onset or to report receipt of influenza vaccination for the previous influenza season. Only 90 (37%) of the respondents were willing to pay >$20 for antiviral medication, although 205 (84%) were willing to pay something.

CONCLUSIONS

Patients are ill-informed about antiviral medication and its benefits, and medication costs may present a barrier to treatment. Physicians should discuss antiviral medication with patients who are at high risk for complications from influenza before the influenza season, and education programs for physicians and patients should be developed.

Knowledge, attitudes, and practices regarding antibiotic use among Latinos in the United States: review and recommendations

Inappropriate use of antibiotics contributes to antimicrobial resistance worldwide. In Latin America, antibiotics are easily obtained over the counter. In the United States, the Latino population is the largest and fastest growing immigrant group. Hence, it is necessary to understand Latino cultural practices in regards to antibiotic use to develop effective interventions that reduce inappropriate antibiotic use among this population. We conducted a systematic review of descriptive and intervention studies measuring knowledge, attitudes, and practices of antibiotic use among Latinos in the United States. The search yielded only 11 descriptive studies and no interventions. The literature suggests that many Latinos in the United States self-prescribe antibiotics because of financial and sociocultural barriers and inaccurately believe that antibiotics help treat viral infections. Increased access to health care and appropriate culturally tailored interventions specific to Latinos are needed to promote judicious antibiotic use among Latinos.

Views on respiratory tract symptoms and antibiotics of Dutch general practitioners, practice staff and patients

OBJECTIVES

To explore views on respiratory tract symptoms (cough, sore throat and earache) and antibiotics of GPs, practice staff, and patients.

METHODS

In a nationwide study, 181 GPs, 204 practice staff members and 1250 patients from 90 practices participated by answering 14 items relating to views on respiratory tract symptoms and antibiotics in a written questionnaire. Differences in means were compared.

RESULTS

Patients more than GPs endorsed the seriousness of respiratory tract symptoms, the need to consult a GP, the need to prescribe antibiotics, and the ability of antibiotics to speed up recovery. GPs were more than patients convinced of the self-limiting character of respiratory tract symptoms and of the fact that antibiotics have side effects. Practice staff took a middle ground in most of these views.

CONCLUSIONS

Differences between GPs, practice staff and patients must be taken into account when exploring patients' complaints and advising on treatment. Education and knowledge programmes for practice staff might be advocated.

Correlates of parental antibiotic knowledge, demand, and reported use

BACKGROUND

Clinicians cite parental misconceptions and requests for antibiotics as reasons for inappropriate prescribing.

AIMS

To identify misconceptions regarding antibiotics and predictors of parental demand for antibiotics and to determine if parental knowledge and attitudes are associated with use.

METHODS

Survey of parents in 16 Massachusetts communities. Domains included antibiotic-related knowledge, attitudes about antibiotics, antibiotic use during a 12-month period, demographics, and access to health information. Bivariate and multivariate analyses evaluated predictors of knowledge and proclivity to demand antibiotics. A multivariate model evaluated the associations of knowledge, demand, and demographic factors with parent-reported antibiotic use.

RESULTS

A total of 1106 surveys were returned (response rates: 54% and 32% for commercially-insured and Medicaid-insured families). Misconceptions were common regarding bronchitis (92%) and green nasal discharge (78%). Two hundred sixty-five (24%) gave responses suggesting a proclivity to demand antibiotics. Antibiotic knowledge was associated with increased parental age and education, having more than 1 child, white race, and receipt of media information on resistance. Factors associated with a proclivity to demand antibiotics included decreased knowledge, pressure from day-care settings, lack of alternatives offered by clinicians, and lack of access to media information. Among all respondents, reported antibiotic use was associated with younger child age and day-care attendance. Among Medicaid-insured children only, less antibiotic knowledge and tendency to demand antibiotics were associated with higher rates of antibiotic use.

CONCLUSIONS

Misconceptions regarding antibiotic use are widespread and potentially modifiable by clinicians and media sources. Particular attention should be paid to Medicaid-insured patients in whom such misconceptions may contribute to inappropriate prescribing.

Rational antibiotic use and academic staff

This study was devised to determine the knowledge, attitude and behaviour of an educated group of people towards antibiotic use and self-medication with antibiotics. Of 1380 members of academic staff (excluding those from the Faculty of Medicine) of Ege University, 602 were chosen by systematic sampling methods. Two groups were formed. Group A included academic staff from the Faculties of Dentistry and Pharmacy and Group B, members of all other faculties. The mean age was 37.4+/-11.0 and 47.0% were females. The mean antibiotic knowledge score was 7.16+/-3.32. Self-medication with antibiotics was admitted by 45.8% of the total samle and 15.6% of the respondents used antibiotics until their symptoms disappeared regardless of the period of prescription. In Group A 48.8% and in Group B 80.7% of the respondents believed that antibiotics could be used for common cold. It is concluded that priority should be given to knowledge-based behaviour education programmes for the more highly educated community; there must also be restriction on the sale of antibiotics without prescription.

Over-the-counter acquisition of antibiotics in the Maltese general population

Few studies have studied the frequency of over-the-counter acquisition of antibiotics in western countries. In order to provide an insight into these practices in Malta, attitudes towards antibiotic use in the general public were researched through a structured interview. Nineteen percent admitted that they took antibiotics without prescription and 11% of parents replied that they had given antibiotics to their children without prescription. These antibiotics were mainly self-administered for upper respiratory tract symptoms, particularly sore throat, with community pharmacies being the major source in more than 85% of cases. The study indicates the need for an educational campaign on proper antibiotic use amongst the Maltese general public.

Acute exacerbation of chronic bronchitis: disease-specific issues that influence the cost-effectiveness of antimicrobial therapy

BACKGROUND

Acute exacerbation of chronic bronchitis (AECB) is a common condition, with substantial associated costs and morbidity. Research efforts have focused on innovations that will reduce the morbidity associated with AECB. Health care payers increasingly expect that the results of evidence-based economic evaluations will guide practitioners in their choice of cost-effective interventions.

OBJECTIVES

To provide a framework on which to base effective and efficient antimicrobial therapy for AECB, we present a concise clinical review of AECB, followed by an assessment of the available data on the economic impact of this disease. We then address several AECB-specific issues that must be considered in cost-effectiveness analyses of AECB antimicrobial interventions.

METHODS

Published literature on the clinical and economic impact of AECB was identified using MEDLINE, pre-MEDLINE, HealthSTAR, CINAHL, Current Contents/All Editions, EMBASE, and International Pharmaceutical Abstracts databases. Other potential sources were identified by searching for references in retrieved articles, review articles, consensus statements, and articles written by selected authorities.

RESULTS

In evaluating cost-effectiveness analyses of AECB antimicrobial therapy it is critical to (1) use the disease-free interval as an outcome measure, (2) evaluate the sequence of multiple therapies, (3) address the impact of both current and future antibiotic resistance, and (4) measure all appropriate AECB-associated costs, both direct and indirect.

CONCLUSIONS

Incorporating these approaches in economic analyses of AECB antimicrobial therapy can help health care organizations make evidence-based decisions regarding the cost-effective management of AECB.

Antibiotic prescribing for patients with colds, upper respiratory tract infections, and bronchitis: A national study of hospital-based emergency departments

STUDY OBJECTIVE

Antibiotics are often used to treat viral upper respiratory tract infections, even though they are usually ineffective. However, frequent inappropriate antibiotic use contributes to the emergence of drug-resistant bacterial pathogens. This study used a national database to evaluate antibiotic use in treating upper respiratory tract infections in emergency departments.

METHODS

Data were obtained from the 1996 National Hospital Ambulatory Medical Care Survey. Antibiotic prescribing rates were examined for colds, upper respiratory tract infections, and acute bronchitis. Patients with comorbid conditions or secondary diagnoses, such as chronic obstructive pulmonary disease, pneumonia, sinusitis, and HIV, were excluded. Bivariate and multivariate analyses were used to assess predictors of antibiotic use.

RESULTS

Overall, there were an estimated 2.7 million ED visits for colds, upper respiratory tract infections, and bronchitis by children and adults in 1996. Antibiotics were prescribed for 24.2% (95% CI 18.9, 29.5) of patients with common colds and upper respiratory tract infections and for 42.2% (95% CI 35.2, 49.2) of patients with bronchitis. There were no significant associations between antibiotic use and patient race, sex, Hispanic ethnicity, geographic location, or source of payment. Antibiotics were prescribed less often by interns or residents than by staff or other physicians (odds ratio 0.43; 95% CI 0.19, 0.98), and patients younger than 18 years were less likely to receive antibiotics than adults (odds ratio 0.32; 95% CI 0.20, 0.52). Smokers were 4.3 (95% CI 2.2, 8.3) times more likely to receive antibiotics than nonsmokers.

CONCLUSION

Antibiotics are commonly prescribed for ED patients with upper respiratory tract infections even though they are usually ineffective in otherwise healthy adults. Efforts should be made to reduce inappropriate antibiotic use for the sake of containing costs, preventing side effects, and limiting the spread of antibiotic resistance.