A Sustainable Strategy to Prevent Misuse of Antibiotics for Acute Respiratory Infections

Over 50% of antibiotics prescriptions are for outpatients with acute respiratory infections (ARI). Many of them are not needed and thus contribute both avoidable adverse events and pressures toward the development of bacterial resistance. Could a clinical decision support system (CDSS), interposed a...

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Bibliographic Details
Published in:PloS one Vol. 7; no. 12; p. e51147
Main Authors: Rattinger, Gail B., Mullins, C. Daniel, Zuckerman, Ilene H., Onukwugha, Eberechukwu, Walker, Loreen D., Gundlapalli, Adi, Samore, Matthew, DeLisle, Sylvain
Format: Journal Article
Language:English
Published: United States Public Library of Science 12.12.2012
Public Library of Science (PLoS)
Subjects:
Acute Disease
Adult
Aged
Algorithms
Ambulatory care
Analysis
Anti-Bacterial Agents - therapeutic use
Antibacterial agents
Antibiotics
Automatic text analysis
Azithromycin
Bacteria
Biology
Bronchitis
Care and treatment
Chronic obstructive pulmonary disease
Decision support systems
Drug resistance
Drug use
Drug Utilization Review
Female
Guidelines
Health aspects
Health care
Humans
Infections
Intervention
Male
Medical diagnosis
Medicine
Middle Aged
Order entry
Patient satisfaction
Patients
Pharmacy
Physicians
Pneumonia
Prescription writing
Respiratory tract infection
Respiratory Tract Infections - drug therapy
Retrospective Studies
Sinusitis
Substance abuse treatment
Sustainability
Systematic review
Teaching methods
Veterans
United States > US
Maryland
Utah
Baltimore Maryland
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:Over 50% of antibiotics prescriptions are for outpatients with acute respiratory infections (ARI). Many of them are not needed and thus contribute both avoidable adverse events and pressures toward the development of bacterial resistance. Could a clinical decision support system (CDSS), interposed at the time of electronic prescription, adjust antibiotics utilization toward consensus treatment guidelines for ARI? This is a retrospective comparison of pre- (2002) and post-intervention (2003-2006) periods at two comprehensive health care systems (intervention and control). The intervention was a CDSS that targeted fluoroquinolone and azithromycin; other antibiotics remained unrestricted. 7000 outpatients visits flagged by an ARI case-finding algorithm were reviewed for congruence with the guidelines (antibiotic prescribed-when-warranted or not-prescribed-when-unwarranted). 3831 patients satisfied the case definitions for one or more ARI: pneumonia (537), bronchitis (2931), sinusitis (717) and non-specific ARI (145). All patients with pneumonia received antibiotics. The relative risk (RR) of congruent prescribing was 2.57 (95% CI = (1.865 to 3.540) in favor of the intervention site for the antibiotics targeted by the CDSS; congruence did not change for other antibiotics (adjusted RR = 1.18 (95% CI = (0.691 to 2.011)). The proportion of unwarranted prescriptions of the targeted antibiotics decreased from 22% to 3%, pre vs. post-intervention (p<0.0001). A CDSS interposed at the time of e-prescription nearly extinguished unwarranted use targeted antibiotics for ARI for four years. This intervention highlights a path toward sustainable antibiotics stewardship for outpatients with ARI.
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Competing Interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare financial support from the Department of Veterans Affairs (SD), the Centers for Disease Control and Prevention (SD and MS), Elan Pharmaceuticals (GBR), the American Foundation for Pharmaceutical Education (GBR) and by the National Institutes of Health (GBR). There were no financial relationships with any organizations that might have an interest in the submitted work in the previous 5 years, and no other relationships or activities that could appear to have influenced the submitted work. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.
Conceived and designed the experiments: GBR CDM EO MS SD. Performed the experiments: GBR AG SD. Analyzed the data: GRB IHZ LDW SD. Wrote the paper: GBR CDM IHZ EO AG MS SD. Obtaining funding: MS SD Administrative, technical, or material support: GBR CDM AG LDW MS SD Study supervision: GBR AG SD.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0051147