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Discover what family physicians advise for upper respiratory tract infections based on the Antibiotics in Moderation pilot project. Learn about concerns, ineffectiveness, adverse effects, and more.
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What family physicians recommend for upper respiratory tract infections Results of the antibiotics in moderation (AIM) pilot project
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
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
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
* Related co-morbiditywould generally be denoted by clinically evident immune suppression and active lung disease &/or congestive heart failure.
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
Distribution of Diagnostic Categories for Patient Encounters *Nonspecific Viral URTI includes Colds, Croup, Laryngitis and Influenza
Drug meta-categories prescribed and recommended for URTI diagnoses
Influence of Patient Age on Drug Meta-Category Choices for URTIs p-values<0.001 for all comparisons
Influence of Co-morbidity on Drug Meta-Category Choices for URTIs p-values<0.001 for all comparisons
Influence of Second Consult for Same Illness on Drug Meta-Category Choices for URTIs p-values<0.001 for all comparisons
Influence of the provision of antibiotic samples on appropriateness of antibiotic choices p-values<0.02 for both comparisons
Antibiotic Prescriptions Received by Adults for URTI Diagnoses * Antibiotics not indicated for this diagnosis
Antibiotics prescribed to adults with acute bronchitis diagnosis *First Line Choice *First Line Choice
Antibiotics prescribed to adults with acute sinusitis diagnosis *First Line Choice *First Line Choice
Antibiotic Prescriptions Received by Children for URTI Diagnoses * Antibiotics not indicated for these diagnoses
Antibiotics prescribed to children with pharyngitis *First Line Choice *First Line Choice *First Line Choice
Antibiotics prescribed to children with acute otitis media *First Line Choice
Non-antibiotic Rx drugs prescribed for Adults for URTI diagnoses
Non-antibiotic Rx drugs prescribed for Children for URTI diagnoses
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.
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