Patient Factors in Inappropriate Antibiotic Prescribing for Upper Respiratory Tract Infection in the Emergency Department

Overview

Journal Malays J Med Sci

Specialty General Medicine

Date 2021 May 7

PMID 33958962

Citations 6

Authors

Azmi Ahmad

Junainah Nor

Ariff Arithra Abdullah

Tuan Hairulnizam Tuan Kamauzaman

Mohd Boniami Yazid

Affiliations

Soon will be listed here.

Abstract

Background: Emergency departments (EDs) are frequently misused for non-emergency cases such as upper respiratory tract infections (URTIs). Flooding of these cases may contribute to inappropriate antibiotic prescribing. The aim of this study was to determine the patient factors associated with inappropriate antibiotic prescribing for URTIs in the EDs.

Methods: This cross-sectional study involved patients over age 3 years old who presented with URTI to the green zone of the ED of a tertiary hospital on the east coast of Malaysia in 2018-2019. Convenient sampling was done. The patients were categorised into two groups according to their McIsaac scores: positive (≥ 2) or negative (< 2). Antibiotics given to the negative McIsaac group were considered inappropriate.

Results: A total of 261 cases were included - 127 with positive and 134 with negative McIsaac scores. The most common symptoms were fever and cough. About 29% had inappropriate antibiotic prescribing with a high rate for amoxycillin. Duration of symptoms of one day or less (OR 18.5; 95% CI: 1.65, 207.10; = 0.018), presence of chills (OR 4.36; 95% CI: 1.13, 16.88; = 0.033) and diagnosis of acute tonsillitis (OR 5.26; 95% CI: 1.76, 15.72; = 0.003) were significantly associated with inappropriate antibiotic prescription.

Conclusion: Factors influencing inappropriate antibiotic prescribing should be pointed out to emergency doctors to reduce its incidence.

Citing Articles

Treatment of Acute Sore Throat in Malaysia: A Consensus of Multidisciplinary Recommendations Using Modified Delphi Methodology.

Abdullah B, Koh K, Mohamed M, Tan V, Mohammad N, Sekawi Z Infect Drug Resist. 2024; 17:4149-4160.

PMID: 39347494 PMC: 11438446. DOI: 10.2147/IDR.S477038.

Impact evaluation of guidelines on antibiotic utilisation & appropriateness in Malaysian public primary care: an interrupted time series analysis.

Lim A, Ab Rahman N, Ong S, Mohamad Azman S, Mohd Rathi F, Ismail M J Pharm Policy Pract. 2024; 17(1):2355666.

PMID: 38845627 PMC: 11155422. DOI: 10.1080/20523211.2024.2355666.

Assessment of Medical Test Overuse and Its Impact on Pediatric Emergency Department Outcomes in Upper Respiratory Tract Infections in a University Hospital in Lithuania.

Nedzinskaite M, Karakaite D, Zubrickyte E, Jankauskaite L Diagnostics (Basel). 2024; 14(10).

PMID: 38786268 PMC: 11119093. DOI: 10.3390/diagnostics14100970.

Overuse of medications in low- and middle-income countries: a scoping review.

Albarqouni L, Palagama S, Chai J, Sivananthajothy P, Pathirana T, Bakhit M Bull World Health Organ. 2023; 101(1):36-61D.

PMID: 36593777 PMC: 9795388. DOI: 10.2471/BLT.22.288293.

Respiratory microorganisms in acute pharyngitis patients: Identification, antibiotic prescription patterns and appropriateness, and antibiotic resistance in private primary care, central Malaysia.

Bo Z, Tan W, Chong C, Lye M, Parmasivam S, Pang S PLoS One. 2022; 17(11):e0277802.

PMID: 36395327 PMC: 9671416. DOI: 10.1371/journal.pone.0277802.

References

McIsaac W, Goel V, To T, Low D . The validity of a sore throat score in family practice. CMAJ. 2000; 163(7):811-5. PMC: 80502. View

Butler C, Kelly M, Hood K, Schaberg T, Melbye H, Serra-Prat M . Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection. Eur Respir J. 2011; 38(1):119-25. DOI: 10.1183/09031936.00133910. View

Smith S, Kern R, Chandra R, Tan B, Evans C . Variations in antibiotic prescribing of acute rhinosinusitis in United States ambulatory settings. Otolaryngol Head Neck Surg. 2013; 148(5):852-9. PMC: 5514556. DOI: 10.1177/0194599813479768. View

Cadieux G, Abrahamowicz M, Dauphinee D, Tamblyn R . Are physicians with better clinical skills on licensing examinations less likely to prescribe antibiotics for viral respiratory infections in ambulatory care settings?. Med Care. 2011; 49(2):156-65. DOI: 10.1097/MLR.0b013e3182028c1a. View

Braun B, Fowles J . Characteristics and experiences of parents and adults who want antibiotics for cold symptoms. Arch Fam Med. 2000; 9(7):589-95. DOI: 10.1001/archfami.9.7.589. View

Schroeck J, Ruh C, Sellick Jr J, Ott M, Mattappallil A, Mergenhagen K . Factors associated with antibiotic misuse in outpatient treatment for upper respiratory tract infections. Antimicrob Agents Chemother. 2015; 59(7):3848-52. PMC: 4468652. DOI: 10.1128/AAC.00652-15. View

Gonzales R, Malone D, Maselli J, Sande M . Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis. 2001; 33(6):757-62. DOI: 10.1086/322627. View

Fine A, Nizet V, Mandl K . Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch Intern Med. 2012; 172(11):847-52. PMC: 3627733. DOI: 10.1001/archinternmed.2012.950. View

Ahmed M, Muyot M, Begum S, Smith P, Little C, Windemuller F . Antibiotic prescription pattern for viral respiratory illness in emergency room and ambulatory care settings. Clin Pediatr (Phila). 2010; 49(6):542-7. DOI: 10.1177/0009922809357786. View

10.

Wald E, Applegate K, Bordley C, Darrow D, Glode M, Marcy S . Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013; 132(1):e262-80. DOI: 10.1542/peds.2013-1071. View

11.

Williams M, Greene G, Naik G, Hughes K, Butler C, Hay A . Antibiotic prescribing quality for children in primary care: an observational study. Br J Gen Pract. 2018; 68(667):e90-e96. PMC: 5774968. DOI: 10.3399/bjgp18X694409. View

12.

Linder J, Singer D . Desire for antibiotics and antibiotic prescribing for adults with upper respiratory tract infections. J Gen Intern Med. 2003; 18(10):795-801. PMC: 1494934. DOI: 10.1046/j.1525-1497.2003.21101.x. View

13.

Coenen S, Michiels B, Renard D, Denekens J, Van Royen P . Antibiotic prescribing for acute cough: the effect of perceived patient demand. Br J Gen Pract. 2006; 56(524):183-90. PMC: 1828261. View

14.

Tham D, Abubakar U, Tangiisuran B . Prevalence and predictors of antibiotic use among children visiting the Emergency Department in a Tertiary Hospital in Malaysia. Eur J Pediatr. 2020; 179(5):743-748. DOI: 10.1007/s00431-019-03560-z. View

15.

Choby B . Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician. 2009; 79(5):383-90. View

16.

Butt A, Navasero C, Thomas B, Al Marri S, Katheeri H, Thani A . Antibiotic prescription patterns for upper respiratory tract infections in the outpatient Qatari population in the private sector. Int J Infect Dis. 2016; 55:20-23. DOI: 10.1016/j.ijid.2016.12.004. View

17.

Shvartzman P, Tabenkin H, Rosentzwaig A, Dolginov F . Treatment of streptococcal pharyngitis with amoxycillin once a day. BMJ. 1993; 306(6886):1170-2. PMC: 1677641. DOI: 10.1136/bmj.306.6886.1170. View

18.

Yoon Y, Park C, Kim J, Hwang K, Lee S, Kim T . Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections. Infect Chemother. 2018; 49(4):326-352. PMC: 5754344. DOI: 10.3947/ic.2017.49.4.326. View

19.

Chan G, Tang S . Parental knowledge, attitudes and antibiotic use for acute upper respiratory tract infection in children attending a primary healthcare clinic in Malaysia. Singapore Med J. 2006; 47(4):266-70. View

20.

Butler C, Hood K, Verheij T, Little P, Melbye H, Nuttall J . Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. BMJ. 2009; 338:b2242. PMC: 3272656. DOI: 10.1136/bmj.b2242. View