Interventions to reduce inappropriate prescribing of antibiotics for acute respiratory tract infections

summary and update of a systematic review

Marian McDonagh, Kim Peterson, Kevin Winthrop, Amy Cantor, Brittany H. Lazur, David Buckley

Research output: Contribution to journalReview article

2 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)3337-3357
Number of pages21
JournalJournal of International Medical Research
Volume46
Issue number8
DOIs
StatePublished - Aug 1 2018

Fingerprint

Inappropriate Prescribing
Respiratory Tract Infections
Anti-Bacterial Agents
Calcitonin
Education
Patient Education
Microbial Drug Resistance
MEDLINE
Respiratory System
Testing
Libraries
Decision support systems
Primary Health Care
Infection

Keywords

  • acute respiratory tract infections
  • adverse consequences
  • Antibiotics
  • overuse
  • resistance
  • review

ASJC Scopus subject areas

  • Biochemistry
  • Cell Biology
  • Biochemistry, medical

Cite this

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title = "Interventions to reduce inappropriate prescribing of antibiotics for acute respiratory tract infections: summary and update of a systematic review",
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{\circledR}, 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.",
keywords = "acute respiratory tract infections, adverse consequences, Antibiotics, overuse, resistance, review",
author = "Marian McDonagh and Kim Peterson and Kevin Winthrop and Amy Cantor and Lazur, {Brittany H.} and David Buckley",
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language = "English (US)",
volume = "46",
pages = "3337--3357",
journal = "Journal of International Medical Research",
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TY - JOUR

T1 - Interventions to reduce inappropriate prescribing of antibiotics for acute respiratory tract infections

T2 - summary and update of a systematic review

AU - McDonagh, Marian

AU - Peterson, Kim

AU - Winthrop, Kevin

AU - Cantor, Amy

AU - Lazur, Brittany H.

AU - Buckley, David

PY - 2018/8/1

Y1 - 2018/8/1

N2 - 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.

AB - 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.

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