Antibiotic expectations of patients attending an emergency department with upper respiratory tract infections: clinical and behavioural determinants of antibiotic use

Abstract

Antibiotics are often prescribed for upper respiratory tract infections (URTIs) in emergency departments (EDs) due to patient requests and expectations perceived by physicians. This study aimed to identify clinical and behavioural factors associated with patient antibiotic expectations. A cross-sectional study was undertaken of 717 patients attending the ED at Tan Tock Seng Hospital for URTIs between June 2016 and November 2018. A questionnaire was administered and electronic medical records were accessed. Principal component analysis was used to derive latent behavioural factors associated with antibiotic use, and these were applied in multi-variable multi-nomial logistic regression analyses. Independent factors associated with patient antibiotic expectations and requests were identified. Patients were predominantly young [mean age 40.5 (standard deviation 14.7) years], had no comorbidities (66.5%, 477/717), presented within <7 days of symptom onset (62.9%, 451/717), and did not fulfil the US Centers for Disease Control and Prevention's influenza-like illness (ILI) criteria (79.1%, 567/717). Behavioural factors identified were: (1) non-compliance with prescribed antibiotic regimen; (2) self-administration of antibiotics that were not prescribed for the illness episode; and (3) self-discontinuation of antibiotics upon experiencing adverse effects or allergies. After adjusting for age, gender, ethnicity, comorbidities, influenza vaccination history, and illness duration, patients with ILI [adjusted odds ratio (OR) 1.73, 95% confidence interval (CI) 1.15-2.59; P=0.008] or who self-administered antibiotics that were not prescribed for an illness episode (adjusted OR 1.28, 95% CI 1.04-1.57; P=0.021) were more likely to expect antibiotics at the ED visit. Patients with ILI or who previously self-administered antibiotics were more likely to expect antibiotics at ED visits. Public education on appropriate antibiotic use is imperative to ensure optimal antibiotic use.