1
|
McDonagh MS, Peterson K, Winthrop K, Cantor A, Lazur BH, Buckley DI. Interventions to reduce inappropriate prescribing of antibiotics for acute respiratory tract infections: summary and update of a systematic review. J Int Med Res 2018; 46:3337-3357. [PMID: 29962311 PMCID: PMC6134646 DOI: 10.1177/0300060518782519] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective Antibiotic overuse contributes to antibiotic resistance and adverse
consequences. Acute respiratory tract infections (RTIs) are the most common
reason for antibiotic prescribing in primary care, but such infections often
do not require antibiotics. We summarized and updated a previously performed
systematic review of interventions to reduce inappropriate use of
antibiotics for acute RTIs. Methods To update the review, we searched MEDLINE®, the Cochrane Library (until
January 2018), and reference lists. Two reviewers selected the studies,
extracted the study data, and assessed the quality and strength of
evidence. Results Twenty-six interventions were evaluated in 95 mostly fair-quality studies.
The following four interventions had moderate-strength evidence of
improved/reduced antibiotic prescribing and low-strength evidence of no
adverse consequences: parent education (21% reduction, no increase return
visits), combined patient/clinician education (7% reduction, no change in
complications/satisfaction), procalcitonin testing for adults with RTIs of
the lower respiratory tract (12%–72% reduction, no increased adverse
consequences), and electronic decision support systems (24%–47% improvement
in appropriate prescribing, 5%–9% reduction, no increased
complications). Conclusions The best evidence supports use of specific educational interventions,
procalcitonin testing in adults, and electronic decision support to reduce
inappropriate antibiotic prescribing for acute RTIs without causing adverse
consequences.
Collapse
Affiliation(s)
- Marian S McDonagh
- 1 The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Kim Peterson
- 1 The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.,6 Evidence-based Synthesis Program (ESP) Coordinating Center, VA Portland Health Care System, Portland, OR, USA
| | - Kevin Winthrop
- 2 Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA.,3 Department of Ophthalmology, Casey Eye Institute, Portland, OR, USA.,5 Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amy Cantor
- 1 The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.,4 Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Brittany H Lazur
- 1 The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - David I Buckley
- 1 The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.,4 Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.,5 Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|