Previous antibiotic-related adverse drug reactions do not reduce expectations for antibiotic treatment of upper respiratory tract infections

Reducing Expectations for Antibiotics in Patients With Upper Respiratory Tract Infections: A Primary Care Randomized Controlled Trial

PURPOSE

Many family practitioners prescribe antibiotics for patients with upper respiratory tract infections (URTIs) to meet patients' expectations. We evaluated the impact of providing brief tablet-based information about antibiotic treatment of URTIs on patients' expectations for antibiotics and on family practitioners' antibiotic-prescribing behavior.

METHODS

We performed a 3-arm randomized controlled trial among patients presenting with URTIs at 2 urban family practices in Auckland, New Zealand, during winter 2018. Participants were randomly allocated to view a presentation about the futility of antibiotic treatment of URTIs, the adverse effects associated with antibiotics, or the benefits of healthy diet and exercise (active control), immediately before their consultation. Before and after viewing the presentations, participants used a Likert scale to rate the strength of their belief that antibiotics are effective for treating URTIs and of their desire to be prescribed an antibiotic. Patients reported whether an antibiotic had been prescribed, and pharmacy dispensing records were reviewed to determine whether an antibiotic was dispensed.

RESULTS

Participants who viewed either the futility or the adverse effects presentation had greater reductions in their expectations to receive antibiotics than the control group. The mean reduction (95% CI) was 1.1 (0.8-1.3) for the futility group, 0.7 (0.4-0.9) for the adverse effects group, and 0.1 (0-0.3) for the control group (Cohen d = 0.7; P <.001). There was no significant difference among the 3 groups with regard to antibiotic prescribing (P = .84) or dispensing (P = .43).

CONCLUSIONS

A brief tablet-based waiting room intervention significantly reduced participants' expectations about receiving antibiotics for URTI immediately before their family practitioner consultation. The intervention did not influence family practitioner prescribing behavior, however.

Patient and provider characteristics and outcomes associated with outpatient antibiotic overuse in acute adult bronchitis

Nonbacterial acute bronchitis leads to many outpatient clinic visits in the US that result in an antibiotic prescription. Understanding antibiotic prescribing patterns and their clinical consequences will help improve antimicrobial stewardship efforts. A retrospective chart review was conducted to identify any correlations between patient and provider characteristics with antibiotic use in adult acute bronchitis (AAB) and to compare the clinical outcomes and rates of health care utilization between those who did and did not receive antibiotics. Study participants included adults with uncomplicated AAB seen by family medicine or internal medicine, specialty, and mid-level practitioners in a Baylor Scott & White Health outpatient facility. Phase 1 investigated whether prescribing rates varied by provider- or patient-level characteristics. Phase 2 compared clinical outcomes and health care utilization between patients who received an antibiotic versus those who did not receive an antibiotic for AAB. Among 35,383 visits for AAB, 81.4% resulted in a prescription for an antibiotic. Physicians >35 years of age and internal and family medicine physicians were more likely to prescribe antibiotics. Health care utilization rates did not differ between cohorts. The number of Clostridium difficile events was negligible.

The use of a poster to reduce expectations to receive antibiotics for a common cold

Many doctors prescribe antibiotics for a cold, to meet patient's expectations. As a result, patient's education about antibiotics and antibiotic resistance forms a major component of the WHO's Global Action Plan on Antimicrobial Resistance. However, it is not known whether simple educational material can change a person's attitudes about antibiotic therapy. We designed three posters about antibiotic treatment for "cold and flu". Hospital inpatients answered a baseline survey and then were asked to look at one of three randomly selected posters. The posters highlighted the futility of antibiotic treatment for colds (futility), the risk of adverse drug reactions from antibiotics (harm), and the issue of antimicrobial resistance (resistance). Participants then completed a follow-up survey. Participants' expectations to receive antibiotics for a "bad cold" reduced significantly after viewing a poster (82/299, 27% expected antibiotics in the baseline survey compared with 13% in the follow-up survey, P < 0.01). Continuing expectation to receive antibiotics after viewing one of the posters was associated with expectation to receive antibiotics in the baseline survey and the strong belief that colds were caused by bacteria. Participants who viewed the resistance poster were more likely to continue to expect antibiotics than participants who viewed the futility poster (OR 2.46, 95%CI 1.16-5.20, P = 0.02). Following discussion of the study, viewing a poster reduced participants' expectations to receive antibiotics for a hypothetical cold. Changing patients' expectations to receive antibiotics using simple educational material about antibiotic futility could lead to significant reductions in antibiotic prescription for viral upper respiratory tract infections.

Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review

BACKGROUND

Antimicrobial resistance is an emerging global threat to health and is associated with increased consumption of antibiotics. Seventy-four per cent of antibiotic prescribing takes place in primary care. Much of this is for inappropriate treatment of acute respiratory tract infections.

AIMS

To review the published literature pertaining to antibiotic prescribing in order to identify and understand the factors that affect primary care providers' prescribing decisions.

METHODS

Six online databases were searched for relevant paper using agreed criteria. One hundred ninety-five papers were retrieved, and 139 were included in this review.

RESULTS

Primary care providers are highly influenced to prescribe by patient expectation for antibiotics, clinical uncertainty and workload induced time pressures. Strategies proven to reduce such inappropriate prescribing include appropriately aimed multifaceted educational interventions for primary care providers, mass media educational campaigns aimed at healthcare professionals and the public, use of good communication skills in the consultation, use of delayed prescriptions especially when accompanied by written information, point of care testing and, probably, longer less pressurised consultations. Delayed prescriptions also facilitate focused personalised patient education.

CONCLUSION

There is an emerging consensus in the literature regarding strategies proven to reduce antibiotic consumption for acute respiratory tract infections. The widespread adoption of these strategies in primary care is imperative.