Recommendations for Upper Respiratory Tract Infections: Antibiotics in Moderation Pilot Project

1. What family physicians recommend for upper respiratory tract infections Results of the antibiotics in moderation (AIM) pilot project

2. Introduction • Antibiotics are all too often prescribed for upper respiratory tract infections (URTIs) • Why be concerned? • Clinical Ineffectiveness • Adverse Effects • Drug Interactions • Bacterial Resistance • Costs Associated with the Above • Little research has been done on the prescribing and recommendation of drugs other than antibiotics for URTIs

3. Purpose • For upper respiratory tract infections (URTIs): • To examine the prescribing rate of antibiotics • To determine antibiotic drug choices • To examine non-antibiotic Rxs • To examine over-the-counter (OTC) recommendations

4. Methods • Data from 1,761 doctor visits for URTIs • 46 family physicians in southeastern Ontario • Physicians recorded consecutive patient encounters, indicating drugs recommended and or prescribed, diagnosis, patient age and sex, co-morbidity and whether repeat visit and sample provided • Patients of all ages were included in the study, those >15 were considered adults

5. * Related co-morbiditywould generally be denoted by clinically evident immune suppression and active lung disease &/or congestive heart failure.

6. Methods Continued • Antibiotic and non-antibiotic prescriptions as well as over-the-counter (OTC) recommendations were outcome measures of interest • The Ontario Anti-infective guidelines which were disseminated Ontario-wide in 1994 and 1997 were the basis for judgements regarding prescribing appropriateness • indication for an antibiotic • antibiotic drug choices

7. Distribution of Diagnostic Categories for Patient Encounters *Nonspecific Viral URTI includes Colds, Croup, Laryngitis and Influenza

8. Drug meta-categories prescribed and recommended for URTI diagnoses

9. Influence of Patient Age on Drug Meta-Category Choices for URTIs p-values<0.001 for all comparisons

10. Influence of Co-morbidity on Drug Meta-Category Choices for URTIs p-values<0.001 for all comparisons

11. Influence of Second Consult for Same Illness on Drug Meta-Category Choices for URTIs p-values<0.001 for all comparisons

12. Influence of the provision of antibiotic samples on appropriateness of antibiotic choices p-values<0.02 for both comparisons

13. Samples Provided by Antibiotic Drug Class

14. Antibiotic Prescriptions Received by Adults for URTI Diagnoses * Antibiotics not indicated for this diagnosis

15. Antibiotics prescribed to adults with acute bronchitis diagnosis *First Line Choice *First Line Choice

16. Antibiotics prescribed to adults with acute sinusitis diagnosis *First Line Choice *First Line Choice

17. Antibiotic Prescriptions Received by Children for URTI Diagnoses * Antibiotics not indicated for these diagnoses

18. Antibiotics prescribed to children with pharyngitis *First Line Choice *First Line Choice *First Line Choice

19. Antibiotics prescribed to children with acute otitis media *First Line Choice

20. Non-antibiotic Rx drugs prescribed for Adults for URTI diagnoses

21. Non-antibiotic Rx drugs prescribed for Children for URTI diagnoses

22. Over-the-counter drugs recommended for adults by URTI

23. Over-the-counter drugs recommended for children by URTI

24. Conclusions • Patient age, co-morbidity, repeat visits, and provision of samples influenced drug prescriptions and recommendations for URTI diagnoses. • Antibiotics were often prescribed inappropriately with respect to indication and drug choice.

25. Recommendations • There is a pressing need to address the problem of antibiotics being prescribed against indication and drug choice. • Stay tuned for the “Impacts of feedback on antibiotic prescribing for upper respiratory tract infections” talk that demonstrates one means of affecting change in this area