Defining the appropriateness and inappropriateness of antibiotic prescribing in primary care
| Autor: | Timo Smieszek, David R M Smith, F Christiaan K Dolk, Julie V. Robotham, Morag Christie, Koen B. Pouwels |
|---|---|
| Přispěvatelé: | PharmacoTherapy, -Epidemiology and -Economics |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Male Acute exacerbation of chronic obstructive pulmonary disease Impetigo Databases Factual Antibiotics Inappropriate Prescribing 0302 clinical medicine Surveys and Questionnaires BAYESIAN PRIORS Sore throat Pharmacology (medical) 030212 general & internal medicine R PACKAGE Practice Patterns Physicians' Child Aged 80 and over Pharyngitis Middle Aged Anti-Bacterial Agents Infectious Diseases Supplement Papers Child Preschool Bronchitis Female medicine.symptom Microbiology (medical) Adult medicine.medical_specialty Adolescent medicine.drug_class 030106 microbiology Primary care Antibiotic prescribing 03 medical and health sciences Young Adult URINARY-TRACT-INFECTION GENERAL-PRACTICE medicine MANAGEMENT Humans DISTRIBUTIONS Medical prescription Sinusitis Intensive care medicine METAANALYSIS Aged Pharmacology ACUTE OTITIS-MEDIA Primary Health Care business.industry INDIVIDUAL PATIENT DATA ADULTS medicine.disease Cough business |
| Zdroj: | Journal of Antimicrobial Chemotherapy, 73, 11-18. Oxford University Press |
| ISSN: | 1460-2091 0305-7453 |
| DOI: | 10.1093/jac/dkx503 |
| Popis: | Objectives: To assess the appropriateness of prescribing systemic antibiotics for different clinical conditions in primary care, and to quantify 'ideal' antibiotic prescribing proportions in conditions for which antibiotic treatment is sometimes but not always indicated. Methods: Prescribing guidelines were consulted to define the appropriateness of antibiotic therapy for the conditions that resulted in antibiotic prescriptions between 2013 and 2015 in The Health Improvement Network (THIN) primary care database. The opinions of subject experts were then formally elicited to quantify ideal antibiotic prescribing proportions for 10 common conditions. Results: Of the antibiotic prescriptions in THIN, 52.5% were for conditions that could be assessed using prescribing guidelines. Among these, the vast majority of prescriptions (91.4%) were for conditions where antibiotic appropriateness is conditional on patient-specific indicators. Experts estimated low ideal prescribing proportions in acute, non-comorbid presentations of many of these conditions, such as cough (10% of patients), rhinosinusitis (11%), bronchitis (13%) and sore throat (13%). Conversely, antibiotics were believed to be appropriate in 75% of non-pregnant women with non-recurrent urinary tract infection. In impetigo and acute exacerbation of chronic obstructive pulmonary disease, experts clustered into distinct groups that believed in either high or low prescribing. Conclusions: In English primary care, most antibiotics are prescribed for conditions that only sometimes require antibiotic treatment, depending on patient-specific indicators. Experts estimated low ideal prescribing proportions in many of these conditions. Incomplete prescribing guidelines and disagreement about prescribing in some conditions highlight further research needs. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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