Hospitalization for Acute Respiratory Tract Infection in a Low-Antibiotic-Prescribing Setting: Cross-Sectional Data from General Practice.

Christin Löffler,Anna Köchling,Annette Diener,Anja Wollny,Christian Helbig,Gregor Feldmeier,Karl Wegscheider,Attila Altiner,Reinhard Berner,Winfried V Kern,Helmut Schröder,Gerhard Schön,Michaela Schmid

doi:10.3390/antibiotics9100653

Abstract

Background: Acute respiratory tract infections (ARTI) are the main cause of inappropriate antibiotic prescribing. To date, there is limited evidence concerning whether low levels of antibiotic prescribing may impact patient safety. We investigate whether antibiotic prescribing for patients seeking primary care for ARTI correlates with the odds for hospitalization. Methods: Analysis of patient baseline data (n = 3669) within a cluster-randomized controlled trial. Adult patients suffering from ARTI in German primary care are included. The main outcome measure is acute hospitalization for respiratory infection and for any acute disease from 0 to 42 days after initial consultation. Results: Neither the antibiotic status of individual patients (OR 0.91; 95% CI: 0.49 to 1.69; p-value = 0.769) nor the physician-specific antibiotic prescription rates for ARTI (OR 1.22; 95% CI: 1.00 to 1.49; p-value = 0.054) had a significant effect on hospitalization. The following factors increased the odds for hospitalization: patient’s age, the ARTI being defined as lower respiratory tract infections (such as bronchitis) by the physician, the physician’s perception of disease severity, and being cared for within group practices (versus treated in single-handed practices). Conclusions: In a low-antibiotic-prescribing primary care setting such as Germany, lack of treatment with antibiotics for ARTI did not result in higher odds for hospitalization in an adult population.

Highlights

In developed countries, acute respiratory tract infections (ARTI) are the leading reason for both consultations in primary care [1] and inappropriate antibiotic prescribing [2,3]
The trial measured antibiotic prescribing rates among primary care physicians for their patients presenting with symptoms of Acute respiratory tract infections (ARTI)
The trial aimed at reducing unnecessary antibiotic prescribing by employing communication training and point-of-care testing (POCT) [18]

Summary

Introduction

Acute respiratory tract infections (ARTI) are the leading reason for both consultations in primary care [1] and inappropriate antibiotic prescribing [2,3]. Misuse and overuse of antibiotics is driving antibiotic resistance, with serious consequences for global health care, including fewer effective therapies for a growing number of infections, longer hospital stays, higher medical costs, and increased mortality [6,7]. Concepts to explain the inappropriate use of antibiotics in ARTIs include physicians’ perceived safety when prescribing antibiotics, perceived patient pressure and conflict avoidance, and—in some rarer cases—inadequate knowledge among physicians [10,11,12]. Acute respiratory tract infections (ARTI) are the main cause of inappropriate antibiotic prescribing. We investigate whether antibiotic prescribing for patients seeking primary care for ARTI correlates with the odds for hospitalization. Results: Neither the antibiotic status of individual patients

Methods

Discussion

Conclusion