Reducing Antibiotic Use in Ambulatory Care Through Influenza Vaccination
| Autor: | Katherine E. Fleming-Dutra, Manjusha Gaglani, Emily T. Martin, Mary Patricia Nowalk, Scott C Olson, Michael L. Jackson, Jill M. Ferdinands, Richard K. Zimmerman, Melissa A Rolfes, Brendan Flannery, Manish M. Patel, Alicia M. Fry, Huong Q. McLean, Lauri A. Hicks, Emily R Smith, Arnold S. Monto |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty medicine.drug_class 030106 microbiology Antibiotics 03 medical and health sciences 0302 clinical medicine Antibiotic resistance Internal medicine Influenza Human medicine Ambulatory Care Humans 030212 general & internal medicine Sinusitis Online Only Articles Aged Respiratory tract infections business.industry Vaccination medicine.disease Pharyngitis United States respiratory tract diseases Anti-Bacterial Agents Infectious Diseases Upper respiratory tract infection Influenza Vaccines Diagnosis code medicine.symptom business |
| Zdroj: | Clin Infect Dis |
| Popis: | Background Improving appropriate antibiotic use is crucial for combating antibiotic resistance and unnecessary adverse drug reactions. Acute respiratory illness (ARI) commonly causes outpatient visits and accounts for ~41% of antibiotics used in the United States. We examined the influence of influenza vaccination on reducing antibiotic prescriptions among outpatients with ARI. Methods We enrolled outpatients aged ≥6 months with ARI from 50–60 US clinics during 5 winters (2013–2018) and tested for influenza with RT-PCR; results were unavailable for clinical decision making and clinical influenza testing was infrequent. We collected antibiotic prescriptions and diagnosis codes for ARI syndromes. We calculated vaccine effectiveness (VE) by comparing vaccination odds among influenza-positive cases with test-negative controls. We estimated ARI visits and antibiotic prescriptions averted by influenza vaccination using estimates of VE, coverage, and prevalence of antibiotic prescriptions and influenza. Results Among 37 487 ARI outpatients, 9659 (26%) were influenza positive. Overall, 36% of ARI and 26% of influenza-positive patients were prescribed antibiotics. The top 3 prevalent ARI syndromes included: viral upper respiratory tract infection (47%), pharyngitis (18%), and allergy or asthma (11%). Among patients testing positive for influenza, 77% did not receive an ICD-CM diagnostic code for influenza. Overall, VE against influenza-associated ARI was 35% (95% CI, 32–39%). Vaccination prevented 5.6% of all ARI syndromes, ranging from 2.8% (sinusitis) to 11% (clinical influenza). Influenza vaccination averted 1 in 25 (3.8%; 95% CI, 3.6–4.1%) antibiotic prescriptions among ARI outpatients during influenza seasons. Conclusions Vaccination and accurate influenza diagnosis may curb unnecessary antibiotic use and reduce the global threat of antibiotic resistance. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|