To Rx or Not to Rx: Interventions to Improve Antibiotic Prescribing for Uncomplicated Acute RTI

Antibiotics
Antibiotics

Despite the fact that guidelines are in place which recommend no antibiotic treatment for uncomplicated acute respiratory tract infections (RTIs), the majority of outpatient antibiotic prescriptions in the U.S. are for acute RTIs. The National Ambulatory and National Hospital Ambulatory Medical Care Surveys from 2013 found that antibiotics were prescribed to 73% of patients who visited their doctor with acute bronchitis, between 1996 and 2010.1 Similarly, a report from 2014 showed that 60% of children diagnosed with pharyngitis were prescribed antibiotics between the years 1997 through 2010.2 This high rate of prescribing across the board raises healthcare costs and in the long-term can continue to increase antibiotic resistance.

The reasons behind overuse of antibiotics for acute RTIs are numerous and extremely complex, as such, any strategy to reduce overuse for acute RTIs has potentially many targets. Those targeted include clinicians treating patients with acute RTIs in outpatient settings, patients with and without acute RTIs, and organizations, such as employers and schools, where attendance policies may indirectly affect antibiotic use. Interventions for appropriate antibiotic use would ideally stop the growth of antibiotic resistance, lessen the number of adverse drug events, and decrease healthcare costs.

A newly published review by researchers at Pacific Northwest Evidence-Based Practice Center on behalf of the Agency for Healthcare Research and Quality, assessed the comparative effectiveness of a plethora of interventions for improving antibiotic prescribing for RTIs. One-hundred and thirty-three studies (88 randomized controlled trials, 40 observational studies, and five systematic reviews in 143 publications) were included in the report; interventions were chosen based on evidence for improving antibiotic prescribing, reducing antibiotic resistance, and decreasing overall inappropriate antibiotic prescribing without adverse consequences (ie, medical complications, patient dissatisfaction). 

Because of study limitations, the only commonly reported benefit across all interventions was reduction in overall prescribing of antibiotics. Very few studies addressed antibiotic resistance or appropriate prescribing, so researchers could not assess the benefit of these interventions for those particular outcomes. In addition, very few studies reported antibiotic use apart from prescribing, so how these interventions played a role in actual use could not be assessed. 

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