Efficacy and safety of discontinuing antibiotic treatment for uncomplicated respiratory tract infections when deemed unnecessary. A multicentre, randomized clinical trial in primary care

Outcomes of antibiotic treatment for respiratory infections in children an observational study in primary care

BACKGROUND

Antibiotic resistance is an increasing global threat, accelerated by both misuse and overuse of antibiotics. Most antibiotics to humans are prescribed in primary care, commonly for respiratory symptoms, and there is a need for research on the usage of and outcomes after antibiotic treatment to counteract antibiotic resistance.

OBJECTIVE

To evaluate symptom duration, treatment length, and adverse events of antibiotic treatment in children.

DESIGN AND SETTING

Observational study at four out-of-hours services and one paediatric emergency clinic in Norwegian emergency primary care.

SUBJECTS

266 children aged 0 to 6 years with fever or respiratory symptoms.

MAIN OUTCOME MEASURES

Duration of symptoms and absenteeism from kindergarten/school, treatment length, and reported adverse events.

RESULTS

There were no differences in duration of symptoms, fever or absenteeism when comparing the groups prescribed (30.8%) and not prescribed (69.2%) antibiotics. This lack of difference remained when analysing the subgroup with otitis media.In the group prescribed antibiotics, 84.5% of parents reported giving antibiotics for 5-7 days, and 50.7% reported no difficulties. Adverse events of antibiotics were reported in 42.3% of the cases, the vast majority being gastrointestinal disturbances.

CONCLUSION

Children with fever or respiratory symptoms experience similar duration of symptoms and absenteeism regardless of antibiotic treatment. A substantial number of parents reported adverse events when the child received antibiotics. Several parents experienced additional difficulties with the treatment, some ending treatment within day 4.

TRIAL REGISTRATION NUMBER

NCT02496559; Results.

Within-episode repeat antibiotic prescriptions in patients with respiratory tract infections: A population-based cohort study

BACKGROUND

Antimicrobial stewardship interventions mainly focus on initial antibiotic prescriptions, with few considering within-episode repeat prescriptions. We aimed to describe the magnitude, type and determinants of within-episode repeat antibiotic prescriptions in patients presenting to primary care with respiratory tract infections (RTIs).

METHODS

We conducted a population-based cohort study among 530 sampled English general practices within the Clinical Practice Research Datalink (CPRD). All individuals with a primary care RTI consultation for which an antibiotic was prescribed between March 2018 and February 2022. Main outcome measurement was repeat antibiotic prescriptions within 28 days of a RTI visit stratified by age (children vs. adults) and RTI type (lower vs. upper RTI). Multivariable logistic regression and principal components analyses were used to identify risk factors and patient clusters at risk for within-episode repeat prescriptions.

FINDINGS

905,964 RTI episodes with at least one antibiotic prescription were identified. In adults, 19.9% (95% CI 19.3-20.5%) had at least one within-episode repeat prescription for a lower RTI, compared to 10.5% (95% CI 10.3-10.8%) for an upper RTI. In children, this was around 10% irrespective of RTI type. The majority of repeat prescriptions occurred a median of 10 days after the initial prescription and was the same antibiotic class in 48.3% of cases. Frequent RTI related GP visits and prior within-RTI-episode repeat antibiotic prescriptions were main factors associated with repeat prescriptions in both adults and children irrespective of RTI type. Young (<2 years) and older (65+) age were associated with repeat prescriptions. Among those aged 2-64 years, allergic rhinitis, COPD and oral corticosteroids were associated with repeat prescriptions.

INTERPRETATIONS

Repeat within-episode antibiotic use accounts for a significant proportion of all antibiotics prescribed for RTIs, with same class antibiotics unlikely to confer clinical benefit and is therefore a prime target for future antimicrobial stewardship interventions.

Exploring barriers and enablers of antibiotic amnesty campaigns

This editorial highlights the different barriers and enablers of antibiotic amnesty campaigns in community pharmacies. The main enablers of antibiotic amnesties included effective counselling and successful use of promotional resources, whilst the main barriers included lack of education in patients and staff. Enabling factors such as effective counselling and use of promotional resources should be continued with patients, whilst the main barriers can be tackled with provision of sufficient education, training, and knowledge for patients. Educating staff, by providing appropriate training to all staff members present in the pharmacy, can positively contribute to the success of antibiotic amnesty campaigns. The findings of this work can inform the development of interventions needed to improve antibiotic amnesties, resulting in more antibiotics being returned and contributing towards tackling the issue of antimicrobial resistance (AMR).

Antibiotic prescription for children with acute respiratory tract infections in rural primary healthcare in Guangdong province, China: a cross-sectional study

OBJECTIVES

The objective of this study is to understand the characteristics and patterns of the first antibiotic prescriptions for children with acute respiratory infections (ARIs) in rural primary healthcare (PHC) in Guangdong province, China.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

We used prescription data generated from the electronic medical record system of 37 township hospitals in two counties of Shaoguan City, Guangdong province. 46 699 first prescriptions for ARIs in children aged 0-18 years were screened from 444 979 outpatient prescriptions recorded between November 2017 and October 2018.

OUTCOME MEASURES

Descriptive analyses were used to report sociodemographic characteristics and antibiotic prescribing profiles. χ2 analysis and binary logistic regression were used to analyse the factors associated with antibiotic prescriptions in children.

RESULTS

Of the 46 699 sampled cases, 83.00% (n=38 759) received at least one antibiotic as part of their first prescription. Of the 38 759 sampled cases treated with antibiotics, 40.76% (n=15 799), 56.15% (n=21 762) and 31.59% (n=12 244) received parenteral antibiotics, broad-spectrum antibiotics and two or more kinds of antibiotics, respectively. Multivariable analysis showed that children aged ≤5 years were less likely to be prescribed with antibiotics than those aged 16-18 years (OR 0.545, p<0.001). Those with health insurance were more likely to be prescribed with antibiotics than those without health insurance (OR 1.677, p<0.001).

CONCLUSIONS

Misuse and overuse of antibiotics were found in the prescriptions of children with ARIs in rural PHC. Antibiotic stewardship programme should be established to reduce the level of antibiotic prescriptions among children with ARIs in rural PHC, especially regarding the prescriptions of broad-spectrum antibiotics and parenteral antibiotics, tailored to different ages, sex and health insurance groups.

The Role of CRP POC Testing in the Fight against Antibiotic Overuse in European Primary Care: Recommendations from a European Expert Panel

Tackling antibiotic resistance represents one of the major challenges in modern medicine, and limiting antibiotics' overuse represents the first step in this fight. Most antibiotics are prescribed in primary care settings, and lower respiratory tract infections (LRTIs) are one of the most common indications for their prescription. An expert panel conducted an extensive report on C-reactive protein point-of-care (CRP POC) testing in the evaluation of LRTIs and its usefulness to limit antibiotic prescriptions. The expert panel stated that CRP POC testing is a potentially useful tool to limit antibiotic prescriptions for LRTI in a community setting. CRP POC must be used in conjunction with other strategies such as improved communication skills and the use of other molecular POC testing. Potential barriers to the adoption of CRP POC testing are financial and logistical issues. Moreover, the efficacy in limiting antibiotic prescriptions could be hampered by the fact that, in some countries, patients may gain access to antibiotics even without a prescription. Through the realization of a better reimbursement structure, the inclusion in standardized procedures in local guidelines, and better patient education, CRP point-of-care testing can represent a cornerstone in the fight against antimicrobial resistance.

Antibiotic deprescribing: Spanish general practitioners' views on a new strategy to reduce inappropriate use of antibiotics in primary care

BACKGROUND

A doctor may recommend that a patient stop an antibiotic course before its scheduled completion time if further treatment may cause more harm than benefit.

OBJECTIVES

This study explores general practitioners' (GP) opinions about the use of antibiotic deprescribing (AD) in general practice.

METHODS

A cross-sectional, questionnaire-based study answered from February to March 2022. GPs (n = 6,083) affiliated with the largest Spanish scientific society of primary care were invited to participate. The survey included two statements related to use and fourteen views about AD rated by GPs using a 5-item Likert scale.

RESULTS

Eleven hundred and seven doctors completed the surveys (18.2%), of whom 92.5% (95% confidence interval [CI] 90.8-94%) reported having used the AD strategy in their practice at least once. GPs felt very confident in using a deprescribing strategy in patients with common cold and influenza (97.6% and 93.5%, respectively) but less with acute bronchitis (45.5%); 12.1% (95% CI, 10.2-14.2%) considered this practice harmful to patients. Respondents reported using AD more frequently when they initiated the antibiotic course (96.8%; 95% CI, 95.5-97.7) than when the treatment was initiated by another doctor (52.3%; 95% CI, 49.3-55.3%). However, doctors aged >60 years were more prone to use AD compared with younger colleagues (64.5% vs. 50%; p < 0.005).

CONCLUSION

The GPs in this study employ the strategy of AD. Nonetheless, essential differences lie in their views of the way the strategy is used. Further studies are warranted to explore the beliefs behind these perceptions and promote wider use of AD by GPs.