Effectiveness of decision support tools on reducing antibiotic use for respiratory tract infections: a systematic review and meta-analysis
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SUBMITTER: Xu R
PROVIDER: S-EPMC10512864 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:Urinary tract infections (UTIs) often prompt empiric outpatient antibiotic prescriptions, risking mismatches. This study evaluates the impact of "UTI Smart-Set" (UTIS), an AI-driven decision-support tool, on prescribing patterns and mismatches in a large outpatient organization. UTIS integrates machine learning forecasts of antibiotic resistance, patient data, and guidelines into a user-friendly order set for UTI management. From 6/1/2021-8/31/2022, 171,010 UTI diagnoses were recorded, with UTIS used in 75,630 cases involving antibiotic prescriptions. Overall acceptance rate of UTIS recommendations was 66.0%. Among 19,287 cases with urine cultures, antibiotic mismatch rate was significantly lower when UTIS recommendations were followed (8.9% vs. 14.2%, p < 0.0001). Among women over 18, mismatch rate was 47.5% lower, and among women over 50, 55.6% lower (p < 0.001). Additionally, an overall reduction of 80.5% in ciprofloxacin usage (6.4% vs 32.9%, p < 0.0001) was observed. UTIS improved prescribing accuracy, reduced mismatches, and minimized quinolone use, highlighting AI's potential for personalized infection management.
| S-EPMC11772748 | biostudies-literature
Project description:BackgroundAddressing antibiotic resistance is important for reducing parents' self-medication of antibiotics for children's upper respiratory tract infections (URTIs). However, the decision-making process for parents who irrationally use such antibiotics is still unclear. In this study, we aimed to explore the reasons why parents self-medicate antibiotics for children's URTIs based on a discrete choice experiment.MethodsWe conducted a systematic review and in-depth interviews to identify the key attributes of choices when parents self-medicate antibiotics for children's URTIs. We developed and applied a discrete choice experiment in Wuhan and Chongqing, China. We used a mixed logit model to determine the impact of various attributes on parents' decisions, while we applied latent class logit models to explore different decision-making patterns within populations.ResultsA total of 400 valid responses were returned from parents. It was shown that symptom severity was the most important in parents' decision-making to self-medicate antibiotics for children's URTIs, followed by risk of side effects or resistance, duration, total cost, onset time of antibiotic, and antibiotic effectiveness. More severe and longer symptoms, perceived higher effectiveness, and fewer side effects of antibiotics consistently were significantly associated with parents' more likely to self-medicate with antibiotics for children's URTIs. There are also different patterns of decision-making of parents, including 'symptoms-oriented,' 'safety-oriented,' and 'comprehensive consideration.' Parents' gender and educational level were associated with decision-making patterns.ConclusionsParents' self-medication of antibiotics for children's URTIs was mainly driven by symptoms, followed by perceived antibiotic value. We recommend a multi-faceted intervention strategy to enhance parents' ability to differentiate mild from severe URTIs, as well as their knowledge of antibiotics.
| S-EPMC11626686 | biostudies-literature
Project description:ObjectiveHappy Audit project is a European-funded survey aimed at reducing antibiotic prescribing for respiratory tract infections (RTI). The aim of this study is to investigate the antibiotic treatment administered for these RTIs in Spain and to find out which criteria are associated with its use.DesignCross-sectional study carried out in January and February 2008.SettingPrimary health care.ParticipantsGeneral practitioners registered all the RTI during a 3-week period using a template.Principal measurementsAge and gender, days with symptoms, signs presented (fever, cough, purulent ear discharge, sore throat, tonsillar exudate, swollen neck glands, dyspnoea, increase in sputum, purulent sputum), diagnosis, antibiotic therapy and demand of antibiotics. A logistic regression with the prescription of antibiotic as the dependent variable was performed.ResultsOut of the 332 physicians invited to participate, 309 filled in and returned the templates (93.1%), registering 16,751 RTIs, with the common cold (39.7%), pharyngitis (14.4%) and acute bronchitis (12.6%) being the most common. Antibiotic therapy was given to 4,675 RTIs (27.9%), mainly for pneumonia (89.9%), tonsillitis (88.9%), and otitis media (87.3%). The criterion most associated with antibiotic therapy was the presence of tonsillar exudate (OR: 32.1; 95CI%: 24.5-42), followed by ear discharge (25.2; 95%CI: 18.2-35) and purulence of sputum (18.1; 95%CI: 15.5-21.2); conversely, cough (OR: 0.4; 95%CI: 0.3-0.5) was considered as protective factor.DiscussionAntibiotic treatment for RTIs is very high in our country. This study provides information on the criteria that predict this antibiotic therapy and is important to take into account if a more rational use of antibiotics is required.
| S-EPMC7022111 | biostudies-literature
Project description:These guidelines were developed as part of the 2016 Policy Research Servicing Project by the Korea Centers for Disease Control and Prevention. A multidisciplinary approach was taken to formulate this guideline to provide practical information about the diagnosis and treatment of adults with acute upper respiratory tract infection, with the ultimate aim to promote the appropriate use of antibiotics. The formulation of this guideline was based on a systematic literature review and analysis of the latest research findings to facilitate evidence-based practice, and focused on key questions to help clinicians obtain solutions to clinical questions that may arise during the care of a patient. These guidelines mainly cover the subjects on the assessment of antibiotic indications and appropriate selection of antibiotics for adult patients with acute pharyngotonsillitis or acute sinusitis.
| S-EPMC5754344 | biostudies-literature
Project description:BackgroundAsynchronous virtual patient care is increasingly used; however, the effectiveness of virtually delivering guideline-concordant care in conjunction with antibiotic stewardship initiatives remains uncertain. We developed a bundled stewardship intervention to improve antibiotic use in E-visits for upper respiratory tract infections (URTIs).MethodsIn this before-and-after study, adult patients who completed E-visits for "cough," "flu," or "sinus symptoms" at Michigan Medicine between January 1, 2018, and September 30, 2020, were included. Patient demographics, diagnoses, and antibiotic details were collected. The multifaceted intervention occurred over 6 months. Segmented linear regression was performed to estimate the effect of the intervention on appropriate antibiotic use for URTI diagnoses (defined as no antibiotic prescribed) and sinusitis (defined as guideline-concordant antibiotic selection and duration). Regression lines were fit to data before the bundled intervention (January 2019) and after the bundled intervention (May 2019).ResultsIn total, 5,151 E-visits were included. The intervention decreased the number of visits for flu, cough, or sinus symptoms prescribed antibiotics from 43.2% to 28.9% (P < .001). Guideline concordance of antibiotic prescriptions improved following the intervention: first-line amoxicillin-clavulanate rose from 37.9% of prescriptions to 66.1% of prescriptions (P < .001), second-line doxycycline rose from 13.8% to 22.7% (P < .001); and median duration of antibiotics decreased from 10 days to 5 days (P < .001).ConclusionsA multifaceted stewardship bundle for E-visits involving both changes in the EMR and audit and feedback improved guideline-concordant antibiotic use for URTIs. This approach can aid stewardship efforts in the ambulatory care setting with regard to telemedicine.
| S-EPMC8828391 | biostudies-literature
Project description:BackgroundClinical guidelines (CG) are used to reduce variability in practice when the scientific evidence is sparse or when multiple therapies are available. The development and implementation of evidence-based CG is intended to organize and provide the best available evidence to support clinical decision making in order to improve quality of care. Upper respiratory tract infections (URTI) are the leading cause of misuse of antibiotics and a CG may reduce the unnecessary antibiotic prescription.MethodsThe aim of this quasi-experimental, before-after study was to analyze the short- and long-term effects of the implementation of a CG to decrease the rate of antibiotic prescription in URTI cases in the emergency department of a third level private hospital in Quito, Ecuador. The study included 444 patients with a main diagnosis of URTI. They were distributed in three groups: a baseline cohort 2011 (n = 114), a first post-implementation cohort 2011 (n = 114), and a later post-implementation cohort 2018 (n = 216). The implementation strategy consisted of five key steps: acceptance of the need for implementation of the CG, dissemination of the CG, an educational campaign, constant feedback, and sustainability of the strategy through continuous training.ResultsThe results of this study show a 42.90% of antibiotic prescription rate before the CG implementation. After the implementation of the CG, the prescription rate of antibiotics was significantly reduced by 24.5% (42.9% vs 18.4%, p<0.0001) and the appropriate antibiotic prescription rate was significantly increased by 44.2% (22.4% vs 66.6%, p<0.0001) in the first post-implementation cohort 2011. There was not a significant difference in antibiotic prescription rate and appropriate antibiotic prescription rate between two post-implementation cohorts: 18.4% vs 25.9% (p = 0.125) and 66.6% vs 50% (p = 0.191), respectively.ConclusionsThe implementation of CGs decreases the rate of antibiotic prescription in URTI cases. The results are remarkable after early implementation, but the effect persists over time. The emphasis must shift from guideline development to strategy implementation.
| S-EPMC8016285 | biostudies-literature
Project description:BackgroundNational quality indicators show little change in the overuse of antibiotics for uncomplicated acute bronchitis. We compared the effect of 2 decision support strategies on antibiotic treatment of uncomplicated acute bronchitis.MethodsWe conducted a 3-arm cluster randomized trial among 33 primary care practices belonging to an integrated health care system in central Pennsylvania. The printed decision support intervention sites (11 practices) received decision support for acute cough illness through a print-based strategy, the computer-assisted decision support intervention sites (11 practices) received decision support through an electronic medical record-based strategy, and the control sites (11 practices) served as a control arm. Both intervention sites also received clinician education and feedback on prescribing practices, as well as patient education brochures at check-in. Antibiotic prescription rates for uncomplicated acute bronchitis in the winter period (October 1, 2009, through March 31, 2010) following introduction of the intervention were compared with the previous 3 winter periods in an intent-to-treat analysis.ResultsCompared with the baseline period, the percentage of adolescents and adults prescribed antibiotics during the intervention period decreased at the printed decision support intervention sites (from 80.0% to 68.3%) and at the computer-assisted decision support intervention sites (from 74.0% to 60.7%) but increased slightly at the control sites (from 72.5% to 74.3%). After controlling for patient and clinician characteristics, as well as clustering of observations by clinician and practice site, the differences for the intervention sites were statistically significant from the control sites (P = .003 for control sites vs printed decision support intervention sites and P = .01 for control sites vs computer-assisted decision support intervention sites) but not between themselves (P = .67 for printed decision support intervention sites vs computer-assisted decision support intervention sites). Changes in total visits, 30-day return visit rates, and proportion diagnosed as having uncomplicated acute bronchitis were similar among the study sites.ConclusionsImplementation of a decision support strategy for acute bronchitis can help reduce the overuse of antibiotics in primary care settings. The effect of printed vs computer-assisted decision support strategies for providing decision support was equivalent.Trial registrationclinicaltrials.gov Identifier: NCT00981994.
| S-EPMC3582762 | biostudies-literature
Project description:OBJECTIVES:To investigate if use of antibiotics was associated with bacterial complications following upper respiratory tract infections (URTIs). DESIGN:Ecological time-trend analysis and a prospective cohort study. SETTING:Primary, outpatient specialist and inpatient care in Stockholm County, Sweden. All analyses were based on administrative healthcare data on consultations, diagnoses and dispensed antibiotics from January 2006 to January 2016. MAIN OUTCOME MEASURES:Ecological time-trend analysis: 10-year trend analyses of the incidence of URTIs, bacterial infections/complications and respiratory antibiotic use. Prospective cohort study: Incidence of bacterial complications following URTIs in antibiotic-exposed and non-exposed patients. RESULTS:The utilisation of respiratory tract antibiotics decreased by 22% from 2006 to 2015, but no increased trend for mastoiditis (p=0.0933), peritonsillar abscess (p=0.0544), invasive group A streptococcal disease (p=0.3991), orbital abscess (p=0.9637), extradural and subdural abscesses (p=0.4790) and pansinusitis (p=0.3971) was observed. For meningitis and acute ethmoidal sinusitis, a decrease in the numbers of infections from 2006 to 2015 was observed (p=0.0038 and p=0.0003, respectively), and for retropharyngeal and parapharyngeal abscesses, an increase was observed (p=0.0214). Bacterial complications following URTIs were uncommon in both antibiotic-exposed (less than 1.5 per 10 000 episodes) and non-exposed patients (less than 1.3 per 10 000 episodes) with the exception of peritonsillar abscess after tonsillitis (risk per 10 000 tonsillitis episodes: 32.4 and 41.1 in patients with no antibiotic treatment and patients treated with antibiotics, respectively). CONCLUSIONS:Bacterial complications following URTIs are rare, and antibiotics may lack protective effect in preventing bacterial complications. Analyses of routinely collected administrative healthcare data can provide valuable information on the number of URTIs, antibiotic use and bacterial complications to patients, prescribers and policy-makers.
| S-EPMC5695332 | biostudies-literature
Project description:BackgroundInappropriate antimicrobial use has been shown to be an important determinant of the emergence of antimicrobial resistance (AMR). Health information technology (HIT) in the form of Computerised Decision Support (CDS) represents an option for improving antimicrobial prescribing and containing AMR.ObjectivesTo evaluate the evidence for CDS in improving quantitative and qualitative measures of antibiotic prescribing in inpatient hospital settings.MethodsA systematic literature search was conducted of articles published from inception to 20th December 2014 using eight electronic databases: MEDLINE, EMBASE, PUBMED, Web of Science, CINAHL, Cochrane Library, HMIC and PsychINFo. An updated systematic literature search was conducted from January 1st 2015 to October 1st 2016 using PUBMED. The search strategy used combinations of the following terms: (electronic prescribing) OR (clinical decision support) AND (antibiotic or antibacterial or antimicrobial) AND (hospital or secondary care or inpatient). Studies were evaluated for quality using a 10-point rating scale.ResultsEighty-one studies were identified matching the inclusion criteria. Seven outcome measures were evaluated: adequacy of antibiotic coverage, mortality, volume of antibiotic usage, length of stay, antibiotic cost, compliance with guidelines, antimicrobial resistance, and CDS implementation and uptake. Meta-analysis of pooled outcomes showed CDS significantly improved the adequacy of antibiotic coverage (n = 13; odds ratio [OR], 2.11 [95% CI, 1.67 to 2.66, p ≤ 0.00001]). Also, CDS was associated with marginally lowered mortality (n = 20; OR, 0.85 [CI, 0.75 to 0.96, p = 0.01]). CDS was associated with lower antibiotic utilisation, increased compliance with antibiotic guidelines and reductions in antimicrobial resistance. Conflicting effects of CDS on length of stay, antibiotic costs and system uptake were also noted.ConclusionsCDS has the potential to improve the adequacy of antibiotic coverage and marginally decrease mortality in hospital-related settings.
| S-EPMC5570266 | biostudies-literature
Project description:BackgroundClinical decision support (CDS) is a promising tool for reducing antibiotic prescribing for acute respiratory infections (ARIs).ObjectiveTo assess the impact of previously effective CDS on antibiotic-prescribing rates for ARIs when adapted and implemented in diverse primary care settings.DesignCluster randomized clinical trial (RCT) implementing a CDS tool designed to guide evidence-based evaluation and treatment of streptococcal pharyngitis and pneumonia.SettingTwo large academic health system primary care networks with a mix of providers.ParticipantsAll primary care practices within each health system were invited. All providers within participating clinic were considered a participant. Practices were randomized selection to a control or intervention group.InterventionsIntervention practice providers had access to an integrated clinical prediction rule (iCPR) system designed to determine the risk of bacterial infection from reason for visit of sore throat, cough, or upper respiratory infection and guide evidence-based evaluation and treatment.Main outcome(s)Change in overall antibiotic prescription rates.Measure(s)Frequency, rates, and type of antibiotics prescribed in intervention and controls groups.Results33 primary care practices participated with 541 providers and 100,573 patient visits. Intervention providers completed the tool in 6.9% of eligible visits. Antibiotics were prescribed in 35% and 36% of intervention and control visits, respectively, showing no statistically significant difference. There were also no differences in rates of orders for rapid streptococcal tests (RR, 0.94; P = 0.11) or chest X-rays (RR, 1.01; P = 0.999) between groups.ConclusionsThe iCPR tool was not effective in reducing antibiotic prescription rates for upper respiratory infections in diverse primary care settings. This has implications for the generalizability of CDS tools as they are adapted to heterogeneous clinical contexts.Trial registrationClinicaltrials.gov (NCT02534987). Registered August 26, 2015 at https://clinicaltrials.gov.
| S-EPMC7652959 | biostudies-literature