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Morrell L, Buchanan J, Roope LSJ, Pouwels KB, Butler CC, Hayhoe B, Tonkin-Crine S, McLeod M, Robotham JV, Holmes A, Walker AS, Wordsworth S. Public preferences for delayed or immediate antibiotic prescriptions in UK primary care: A choice experiment. PLoS Med 2021; 18:e1003737. [PMID: 34460825 PMCID: PMC8439451 DOI: 10.1371/journal.pmed.1003737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 09/14/2021] [Accepted: 07/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Delayed (or "backup") antibiotic prescription, where the patient is given a prescription but advised to delay initiating antibiotics, has been shown to be effective in reducing antibiotic use in primary care. However, this strategy is not widely used in the United Kingdom. This study aimed to identify factors influencing preferences among the UK public for delayed prescription, and understand their relative importance, to help increase appropriate use of this prescribing option. METHODS AND FINDINGS We conducted an online choice experiment in 2 UK general population samples: adults and parents of children under 18 years. Respondents were presented with 12 scenarios in which they, or their child, might need antibiotics for a respiratory tract infection (RTI) and asked to choose either an immediate or a delayed prescription. Scenarios were described by 7 attributes. Data were collected between November 2018 and February 2019. Respondent preferences were modelled using mixed-effects logistic regression. The survey was completed by 802 adults and 801 parents (75% of those who opened the survey). The samples reflected the UK population in age, sex, ethnicity, and country of residence. The most important determinant of respondent choice was symptom severity, especially for cough-related symptoms. In the adult sample, the probability of choosing delayed prescription was 0.53 (95% confidence interval (CI) 0.50 to 0.56, p < 0.001) for a chesty cough and runny nose compared to 0.30 (0.28 to 0.33, p < 0.001) for a chesty cough with fever, 0.47 (0.44 to 0.50, p < 0.001) for sore throat with swollen glands, and 0.37 (0.34 to 0.39, p < 0.001) for sore throat, swollen glands, and fever. Respondents were less likely to choose delayed prescription with increasing duration of illness (odds ratio (OR) 0.94 (0.92 to 0.96, p < 0.001)). Probabilities of choosing delayed prescription were similar for parents considering treatment for a child (44% of choices versus 42% for adults, p = 0.04). However, parents differed from the adult sample in showing a more marked reduction in choice of the delayed prescription with increasing duration of illness (OR 0.83 (0.80 to 0.87) versus 0.94 (0.92 to 0.96) for adults, p for heterogeneity p < 0.001) and a smaller effect of disruption of usual activities (OR 0.96 (0.95 to 0.97) versus 0.93 (0.92 to 0.94) for adults, p for heterogeneity p < 0.001). Females were more likely to choose a delayed prescription than males for minor symptoms, particularly minor cough (probability 0.62 (0.58 to 0.66, p < 0.001) for females and 0.45 (0.41 to 0.48, p < 0.001) for males). Older people, those with a good understanding of antibiotics, and those who had not used antibiotics recently showed similar patterns of preferences. Study limitations include its hypothetical nature, which may not reflect real-life behaviour; the absence of a "no prescription" option; and the possibility that study respondents may not represent the views of population groups who are typically underrepresented in online surveys. CONCLUSIONS This study found that delayed prescription appears to be an acceptable approach to reducing antibiotic consumption. Certain groups appear to be more amenable to delayed prescription, suggesting particular opportunities for increased use of this strategy. Prescribing choices for sore throat may need additional explanation to ensure patient acceptance, and parents in particular may benefit from reassurance about the usual duration of these illnesses.
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Affiliation(s)
- Liz Morrell
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - James Buchanan
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
- NIHR Biomedical Research Centre Oxford, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Laurence S. J. Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
- NIHR Biomedical Research Centre Oxford, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Koen B. Pouwels
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
| | - Christopher C. Butler
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Primary Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Sarah Tonkin-Crine
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Primary Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Monsey McLeod
- NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom
- Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London, United Kingdom
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, United Kingdom
| | - Julie V. Robotham
- Modelling and Economics Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Alison Holmes
- NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom
| | - A. Sarah Walker
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
- NIHR Biomedical Research Centre Oxford, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
- NIHR Biomedical Research Centre Oxford, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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Butler CC, Gillespie D, White P, Bates J, Lowe R, Thomas-Jones E, Wootton M, Hood K, Phillips R, Melbye H, Llor C, Cals JWL, Naik G, Kirby N, Gal M, Riga E, Francis NA. C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. N Engl J Med 2019; 381:111-120. [PMID: 31291514 DOI: 10.1056/nejmoa1803185] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD). METHODS We performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD in their primary care clinical record who consulted a clinician at 1 of 86 general medical practices in England and Wales for an acute exacerbation of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging from 0 (very good COPD health status) to 6 (extremely poor COPD health status) (to show noninferiority). RESULTS A total of 653 patients underwent randomization. Fewer patients in the CRP-guided group reported antibiotic use than in the usual-care group (57.0% vs. 77.4%; adjusted odds ratio, 0.31; 95% confidence interval [CI], 0.20 to 0.47). The adjusted mean difference in the total score on the Clinical COPD Questionnaire at 2 weeks was -0.19 points (two-sided 90% CI, -0.33 to -0.05) in favor of the CRP-guided group. The antibiotic prescribing decisions made by clinicians at the initial consultation were ascertained for all but 1 patient, and antibiotic prescriptions issued over the first 4 weeks of follow-up were ascertained for 96.9% of the patients. A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of follow-up (59.1% vs. 79.7%, for a difference of 20.6 percentage points; adjusted odds ratio, 0.30; 95% CI, 0.20 to 0.46). Two patients in the usual-care group died within 4 weeks after randomization from causes considered by the investigators to be unrelated to trial participation. CONCLUSIONS CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm. (Funded by the National Institute for Health Research Health Technology Assessment Program; PACE Current Controlled Trials number, ISRCTN24346473.).
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Affiliation(s)
- Christopher C Butler
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - David Gillespie
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Patrick White
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Janine Bates
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Rachel Lowe
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Emma Thomas-Jones
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Mandy Wootton
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Kerenza Hood
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Rhiannon Phillips
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Hasse Melbye
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Carl Llor
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Jochen W L Cals
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Gurudutt Naik
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Nigel Kirby
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Micaela Gal
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Evgenia Riga
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
| | - Nick A Francis
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford (C.C.B., E.R.), the Centre for Trials Research (D.G., J.B., R.L., E.T.-J., K.H., N.K.), the Division of Population Medicine (R.P., G.N., N.A.F.), and Wales Centre for Primary and Emergency Research, School of Medicine (M.G.), Cardiff University, the Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales (M.W.), Cardiff, and the School of Population Health and Environment Science, King's College, London (P.W.) - all in the United Kingdom; the General Practice Research Unit, Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway (H.M.); the University Institute in Primary Care Research Jordi Gol, Via Roma Health Center, Barcelona (C.L.); and the Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (J.W.L.C.)
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Piltcher OB, Kosugi EM, Sakano E, Mion O, Testa JRG, Romano FR, Santos MCJ, Di Francesco RC, Mitre EI, Bezerra TFP, Roithmann R, Padua FG, Valera FCP, Lubianca Neto JF, Sá LCB, Pignatari SSN, Avelino MAG, Caixeta JADS, Anselmo-Lima WT, Tamashiro E. How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel. Braz J Otorhinolaryngol 2018; 84:265-279. [PMID: 29588108 PMCID: PMC9449220 DOI: 10.1016/j.bjorl.2018.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/01/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. OBJECTIVES To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. METHODS A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. RESULTS Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'. CONCLUSIONS Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use.
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Affiliation(s)
- Otávio Bejzman Piltcher
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina (FAMED), Departamento de Oftalmologia e Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Eduardo Macoto Kosugi
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Eulalia Sakano
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Oftalmologia, Campinas, SP, Brazil
| | - Olavo Mion
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Disciplina de Otorrinolaringologia, São Paulo, SP, Brazil
| | - José Ricardo Gurgel Testa
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Fabrizio Ricci Romano
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Otorrinolaringologia, São Paulo, SP, Brazil; Hospital Infantil Sabará, Otorrinolaringologia, São Paulo, SP, Brazil
| | - Marco Cesar Jorge Santos
- Hospital Paranaense de Otorrinolaringologia (IPO), Instituto Paranaense de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Renata Cantisani Di Francesco
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Disciplina de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Edson Ibrahim Mitre
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Thiago Freire Pinto Bezerra
- Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia, Divisão de Otorrinolaringologia, Recife, PE, Brazil
| | - Renato Roithmann
- Universidade Luterana do Brasil, Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Francini Greco Padua
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), São Paulo, SP, Brazil; Hospital Albert Einstein, São Paulo, SP, Brazil
| | - Fabiana Cardoso Pereira Valera
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - José Faibes Lubianca Neto
- Universidade Federal de Ciências da Saúde de Porto Alegre, Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil
| | - Leonardo Conrado Barbosa Sá
- Universidade do Estado do Rio de Janeiro (UERJ), Faculdade de Ciências Médicas, Disciplina de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Shirley Shizue Nagata Pignatari
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Melissa Ameloti Gomes Avelino
- Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil; Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brazil
| | | | - Wilma Terezinha Anselmo-Lima
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Edwin Tamashiro
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil.
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