Use For Upper Respiratory Infections Research Articles

The public's antibiotic use behavioural patterns and their determinants for upper respiratory tract infections: a latent class analysis based on consumer behaviour model in China.

The irrational use of antibiotics among the public is a major contributor to antimicrobial resistance (AMR), which is a serious global threat. Prior studies have demonstrated that there are different behavioural patterns regarding antibiotic use among the public, and targeted interventions for subgroups with different behavioural patterns may be more effective. Thus, this study aimed to identify the public's behavioural patterns of antibiotic use for upper respiratory tract infections (URTIs) and their influencing factors. A cross-sectional survey was conducted among the general population in Chongqing, China. Consumer decision-making (Consumer Behaviour Model, CBM) was used to assess the public's behaviours regarding antibiotic use, including need recognition, information searching, alternative evaluation, obtaining antibiotics, antibiotic consumption, and postuse evaluation. Furthermore, a latent class analysis was used to identify the underlying behavioural patterns among the public. The identified behavioural patterns of antibiotic use were further linked with individuals' capacity, opportunity, and motivation factors of antibiotic use based on a multinominal logistic regression to explore possible determinants. A total of 815 respondents were enrolled in the study. The public's irrational use of antibiotics was prevalent, including antibiotic self-medication (39.63%), nonprescription antibiotic purchasing (59.02%), and early stopping of antibiotic prescriptions (76.56%). Participants had inadequate knowledge of antibiotics (Mean = 2.33, SD = 1.71), reported high availability to antibiotics (Mean = 7.13, SD = 2.41), held strong belief in antibiotic effectiveness (Mean = 10.29, SD = 2.71), and demonstrated a high perceived threat of AMR (Mean = 12.30, SD = 3.20). Four behavioural patterns regarding antibiotic use for URTIs were identified, namely, "antibiotic self-medicators" (n = 165, 20.25%), "formal health care seekers" (n = 216, 26.50%), "various treatment users" (n = 198, 24.20%), and "self-medication without antibiotics" (n = 236, 28.96%). Individuals' self-efficacy of antibiotic use, belief in antibiotic effectiveness, awareness of antibiotic side effects, perceived antibiotic availability, social influence, and demographics (age, education, medical insurance, and having a medical background) were significantly associated with the public's different behavioural patterns of antibiotic use for URTIs. This study calls for collaborative efforts among the public, physicians, policy makers, and the implementation of precise and multifaceted interventions to effectively reduce irrational use of antibiotics in the public. Such interventions include identifying subgroups within the public to provide more targeted education about antibiotics and the management of URTIs, reinforcing the regulation of antibiotic dispensing, and improving physicians' rational antibiotic prescriptions.

Development and evaluation of a continuous quality improvement programme for antimicrobial stewardship in six hospitals in Uganda

BackgroundAppropriate antimicrobial use is essential for antimicrobial stewardship (AMS). Ugandan hospitals are making efforts to improve antibiotic use, but improvements have not been sufficiently documented and evaluated.MethodsSix Ugandan hospitals implemented...

Factors Associated With Clinician Self-Reported Resource Use in Acute Care and Ambulatory Pediatrics.

The objective of this study is to determine predictors of resource use among pediatric providers for common respiratory illnesses. We surveyed pediatric primary care, emergency department (ED)/urgent care (UC), and hospital medicine providers at a free-standing children's hospital system. Five clinical vignettes assessed factors affecting resource use for upper respiratory infections, bronchiolitis, and pneumonia, including provider-type, practice location, tolerance to uncertainty, and medical decision-making behaviors. The response rate was 75.3% (168/223). The ED/UC and primary care providers had higher vignette scores, indicating higher resource use, compared with inpatient providers; advanced practice providers (APPs) had higher vignette scores compared with physicians. In multivariate analysis, being an ED/UC provider, an APP, and greater concern for bad outcomes were associated with higher vignette scores. Overall, provider type and location of practice may predict resource use for children with respiratory illnesses. Interventions targeted at test-maximizing providers may improve quality of care and reduce resource burden.

Improving Pharmacists' Awareness of Inadequate Antibiotic Use for URTIs through an Educational Intervention: A Pilot Study.

The inadequate use of antibiotics led to the development of multi-resistant bacteria that are now causing millions of deaths worldwide. Since most antibiotics are prescribed/dispensed to treat respiratory tract infections, it is important to raise awareness among health professionals to optimize antibiotic use, especially within the primary care context. Thus, this pilot study aimed to evaluate pharmacists’ feedback about the eHealthResp platform, composed by an online course and a mobile application (app) to help in the management of upper respiratory tract infections (URTIs). Ten community pharmacists were invited to participate in this study, exploring the contents of the eHealthResp platforms and answering a content validation questionnaire composed by eight qualitative and thirty-five quantitative questions about the online course and mobile app. The eHealthResp platform is a comprehensive, consistent, and high-quality e-learning tool. Median scores of 5.00 were attributed to the course contents’ and clinical cases’ adequacy and correction. Most qualitative feedback was about completeness and objectivity of the course, and its usefulness for clinical practice. This study showed that eHealthResp has great potential as an e-health tool for the management of URTIs’ symptoms, which may ultimately aid in reducing inappropriate antibiotic use.

Antibiotic Prescribing Practices for Upper Respiratory Tract Infections Among Primary Care Providers: A Descriptive Study.

BackgroundMost antibiotics are prescribed in the ambulatory setting with estimates that up to 50% of use is inappropriate. Understanding factors associated with antibiotic misuse is essential to advancing better stewardship in this setting. We sought to assess the frequency of unnecessary antibiotic use for upper respiratory infections (URIs) among primary care providers and identify patient and provider characteristics associated with misuse.MethodsUnnecessary antibiotic prescribing was assessed in a descriptive study by using adults ≥18 years seen for common URIs in a large, Upper Midwest, integrated health system, electronic medical records from June 2017 through May 2018. Individual provider rates of unnecessary prescribing were compared for primary care providers practicing in the departments of internal medicine, family medicine, or urgent care. Patient and provider characteristics associated with unnecessary prescribing were identified with a logistic regression model.ResultsA total of 49 463 patient encounters were included. Overall, antibiotics were prescribed unnecessarily for 42.2% (95% confidence interval [CI], 41.7–42.6) of the encounters. Patients with acute bronchitis received unnecessary antibiotics most frequently (74.2%; 95% CI, 73.4–75.0). Males and older patients were more likely to have an unnecessary antibiotic prescription. Provider characteristics associated with higher rates of unnecessary prescribing included being in a rural practice, having more years in practice, and being in higher volume practices such as an urgent care setting. Fifteen percent of providers accounted for half of all unnecessary antibiotic prescriptions.ConclusionsAlthough higher-volume practices, a rural setting, or longer time in practice were predictors, unnecessary prescribing was common among all providers.

Prevention at Full Steam ‐ Can Steam Inhalation Stop the Contagion of Sars‐Cov 2?

Covid‐19 vaccination and social barrier efforts worldwide have deescalated the death and morbidity toll due to Sars CoV‐2 infection in most countries. However, intramuscular vaccination leads to a variable antibody response insufficient to provide airway mucosal immunity that prevents contagion and reinfection in asymptomatic carriers. Nasal vaccines could provide this missing piece and are currently being tested with encouraging results, but large‐scale availability and efficacy in humans are unknown. Moreover, previous exposure to the virus would render nasal spray vaccines less effective. Past literature on upper airway infections has shown that water steam inhalation therapy (WSIT) may modulate airway mucosa immunity responses. Airway mucosal immunity in COVID‐19 infection is a critical aspect to consider with WSIT. Based on a small but slowly growing body of evidence, we propose that WSIT may be a relevant home remedy worth revisiting to help halt mass contagion. Here, we review current and past studies on WSIT use in upper respiratory infections (URI). Previous studies reported mixed results on the efficacy of steam therapy on viral respiratory diseases. Safety concerns with steam therapy include possible nosocomial infections associated and burns. There is a paucity of studies with high methodological quality exploring the outcomes of this ancient therapy. Upper airway blood flow increases substantially after 15‐min of steam inhalation with temperatures of 42 ℃. Still, methods to measure bronchial blood flow are lacking, and this may be an essential variable for the analysis of how steam may impact mucosal immune responses. Studies with better methodologies demonstrate that nebulized steam at 80°C for 20 min reduces neutrophils compared to controls in COPD patients indicating an anti‐inflammatory effect. The best evidence for using WSIT for upper airway viral disease shows that 60% of asymptomatic carriers increased viral shedding immediately post steam inhalation, and Rt‐PCR testing confirmed viral negativity at 10‐days post‐treatment. Subjects used steam for a total of 20 minutes per hour with steam temperatures ranging from 55 to 65℃. Efficacy rates decline with research methodologies that use WSIT for less than 20 minutes. In summary, more recent studies using WSIT for URI show encouraging results and may help to disentangle former controversies. Lessons emerging from previous studies indicate that exposure of WSIT less than 20 minutes may be ineffective. Adopting WSIT as an inexpensive public health measure may lead to secondary prevention of airway viral infections, especially in new viral strands that have the potential to become pandemic.

Exploring the economic impact of inappropriate antibiotic use: the case of upper respiratory tract infections in Ghana

BackgroundAntibiotic consumption is increasing worldwide, particularly in low and middle-income countries (LMICs). Access to lifesaving antibiotics in LMICs is crucial while minimising inappropriate use. Studies assessing the economic impact of inappropriate antibiotic use in LMICs are lacking. We explored the economic impact of inappropriate antibiotic use using the example of upper respiratory tract infections (URIs) in Ghana, as part of the ABACUS (AntiBiotic ACcess and USe) project.MethodsA top-down, retrospective economic impact analysis of inappropriate antibiotic use for URIs was conducted. Two inappropriate antibiotic use situations were considered: (1) URIs treated with antibiotics, against recommendations from clinical guidelines; and (2) URIs that should have been treated with antibiotics according to clinical guidelines, but were not. The analysis included data collected in Ghana during the ABACUS project (household surveys and exit-interviews among consumers buying antibiotics), scientific literature and stakeholder consultations. Included cost types related to health care seeking behaviour for URIs. Additionally, cost saving projections were computed based on potential effects of future interventions that improve antibiotic use.ResultsHealth care costs related to inappropriate antibiotic use for URIs were estimated to be around 20 million (M) USD annually, including 18 M USD for situation 1 and 2 M USD for situation 2. Travel costs and lost income due to travel, together, were estimated to be around 44 M USD for situation 1 and 18 M USD for situation 2. Possible health care cost savings range from 2 to 12 M USD for situation 1 and from 0.2 to 1 M USD for situation 2.ConclusionsThis study indicates that inappropriate antibiotic use leads to substantial economic costs in a LMIC setting that could have been prevented. We recommend investment in novel strategies to counter these unnecessary expenditures. As the projections indicate, this may result in considerable cost reductions. By tackling inappropriate use, progress can be made in combatting antibiotic resistance.

KNOWLEDGE, ATTITUDE, AND PRACTICE OF PARENTS REGARDING ANTIBIOTIC USAGE IN TREATING CHILDRENS UPPER RESPIRATORY TRACT INFECTION ATTENDING PRIMARY HEALTH CARE CENTERS IN AL-MADINAH CITY

Background: Upper respiratory tract infections are common in children and represent a significant cause of antibiotic abuse. Parents knowledge and attitudes often contribute to inappropriate prescription of antibiotics and promoting antibiotics resistance. Aims and objectives: This study was conducted to assess parental knowledge and to identify their attitudes and practices related to antibiotic use in the treatment of childhood upper respiratory tract infections (URTIs). Methods: This cross‐sectional study is conducted in Al-Madinahcity using validated and translated questionnaire which was distributed toattending parents in primary health care centers. Results: The results show that the Parents have moderate level of knowledge of the use of antibiotics for upper respiratory tract infections in children. The majorityof parents (50.9%) correctly sated that respiratory infections are often caused by a virus and do not need antibiotics. In this study, the majority of parents (40.1%) sated that Antibiotics should be given to all children when they develop a fever (high temperature). 21.4% of the of parents indicate that Antibiotics do not have any side effects. Regard to Parents practice toward the use of antibiotics for upper respiratory tract infections in children. The results of this study showed that (46.3%) 0f therespondents stated the most common symptoms leading to a visit to the physician is fever. n this study, (64.7%) of the of parents indicate that they thought that their physiciansprescribed antibiotics only because they asked him or her to do so. Also, (68.9%) of the of parents indicated that they asked the doctor directly to prescribe their child an antibiotic. Regard to Parents attitude about the use of antibiotics for upper respiratory tract infections in children. The results of this study showed that moderate level of attitudeof the use of antibiotics for upper respiratory tract infections in children(61.7%) of the parents stated that antibiotics are used too much and unnecessarily, And (28.8%) of the parents indicated that they would change pediatrician because he/she did not prescribe antibiotics for their child as you wanted. Conclusion:the findings of this study demonstrated that most of the participants were educated but misconceptions regarding antibiotic use in URTIs in children. This misconceptions led to inappropriate attitude and practice. Thus, launching public educational campaigns and encouraging physicians to educate parents regarding the proper use of antibiotics are recommended.

Knowledge and perceptions of outpatients regarding upper respiratory tract infections and awareness of an Antibiotics Smart Use campaign in Thailand

AbstractIntroductionThe Antibiotic Smart Use (ASU) campaign, including educating the public in appropriate antibiotic use for upper respiratory tract infections (URTIs), has been conducted for several years in Thailand. This study's main objectives were to examine knowledge and perceptions of antibiotics for URTIs in outpatients.MethodsA cross‐sectional survey was conducted at a 500‐bed tertiary care teaching hospital, using a self‐administered questionnaire directly distributed to people waiting for dispensed medicines in the out‐patient department.ResultsOf the 400 returned questionnaires, 61% of respondents (N = 243) had a history of antibiotic use. Nearly 70% (N = 270) had received antibiotic information. Posters promoting the ASU campaign had been seen by 65% (N = 259), of whom 70% (N = 182) had read the poster. Knowledge regarding antibiotics was generally poor, higher knowledge (2.6–3.2‐fold increase) was associated with middle‐aged compared to younger people (58.4% vs 31.2%, p = 0.004), people with a bachelor’s degree rather than a junior high school certificate (67.5% vs 14.3%, p = 0.020), and people receiving antibiotic information rather than not receiving information (84.4% vs 15.6%, p = 0.022). The perceived necessity for antibiotics for various respiratory symptoms was moderate, with lower expectations in those who have a high level of antibiotic knowledge and have read an ASU poster.ConclusionOverall knowledge of antibiotics was found to be low. However, perceptions of the necessity for antibiotic use in URTIs were encouragingly positive. Continuous promotion of ASU campaigns to limit antibiotic use is still necessary but may require adaptation to ensure accessibility for the wider public.

Improving antibiotic use for sinusitis and upper respiratory tract infections: A virtual-visit antibiotic stewardship initiative.

Asynchronous virtual patient care is increasingly used; however, the effectiveness of virtually delivering guideline-concordant care in conjunction with antibiotic stewardship initiatives remains uncertain. We developed a bundled stewardship intervention to improve antibiotic use in E-visits for upper respiratory tract infections (URTIs). In this before-and-after study, adult patients who completed E-visits for "cough," "flu," or "sinus symptoms" at Michigan Medicine between January 1, 2018, and September 30, 2020, were included. Patient demographics, diagnoses, and antibiotic details were collected. The multifaceted intervention occurred over 6 months. Segmented linear regression was performed to estimate the effect of the intervention on appropriate antibiotic use for URTI diagnoses (defined as no antibiotic prescribed) and sinusitis (defined as guideline-concordant antibiotic selection and duration). Regression lines were fit to data before the bundled intervention (January 2019) and after the bundled intervention (May 2019). In total, 5,151 E-visits were included. The intervention decreased the number of visits for flu, cough, or sinus symptoms prescribed antibiotics from 43.2% to 28.9% (P < .001). Guideline concordance of antibiotic prescriptions improved following the intervention: first-line amoxicillin-clavulanate rose from 37.9% of prescriptions to 66.1% of prescriptions (P < .001), second-line doxycycline rose from 13.8% to 22.7% (P < .001); and median duration of antibiotics decreased from 10 days to 5 days (P < .001). A multifaceted stewardship bundle for E-visits involving both changes in the EMR and audit and feedback improved guideline-concordant antibiotic use for URTIs. This approach can aid stewardship efforts in the ambulatory care setting with regard to telemedicine.

159. Improving Antibiotic Use for Sinusitis and Upper Respiratory Tract Infections: A Virtual Visit Antibiotic Stewardship Initiative

BackgroundAsynchronous virtual patient care is growing in popularity; however, the effectiveness of virtually delivering guideline-concordant care in conjunction with antibiotic stewardship initiatives remains uncertain. We developed a bundled stewardship intervention aimed at improving antibiotic use in E-visits for upper respiratory tract infections (URTIs).MethodsIn this pre-post study, adult patients who completed an E-visit for “cough,” “flu,” or “sinus symptoms” at Michigan Medicine between 1/1/2018 and 9/30/2020 were included. Patient demographics, diagnoses, and antibiotic details were collected. The multi-faceted intervention occurred over 6 months (Figure 1).We performed segmented linear regression to estimate the effect of the intervention on the level and trend of appropriate antibiotic use for URTI diagnosis (defined as no antibiotic prescribed) and sinusitis (defined as guideline-concordant antibiotic selection and duration). Regression lines were fit to data before (March 2019) and after (May 2019) the physician championing period. ResultsAmong 5151 E-visits, the mean age was 46 years old, and most patients were female (71.3%, N=3674). 3405/5151 E-visits were for URTI. Inappropriate antibiotic use for URTI was stable in trend prior to the audit and feedback intervention (Figure 2), followed by a 12% (P-value = 0.01) decrease in inappropriate antibiotic use post-intervention. The trend in inappropriate antibiotic use continued to decrease after the intervention by 1.1%/month (P-value = 0.02) (Figure 2a).Of 2493/5151 E-visits specifically for sinus symptoms, guideline-concordant antibiotic use was low (intercept = 8%) pre-intervention (Figure 2b). Post-intervention, there was an estimated 47% increase (P-value < 0.001) in patients receiving guideline-concordant antibiotics. Solid line represents time of the webinar, dashed line represents time of modified questionnaire roll out and electronic medical record “nudges”, and shaded area is time of physician champion intervention. Guideline-concordant antibiotic prescribing for sinusitis included amoxicillin/clavulanate or doxycycline prescribed for a duration of 5-7 daysConclusionA multifaceted stewardship bundle for E-visits improved guideline-concordant antibiotic use for URTIs. Changes implemented in the EMR are most beneficial after a period of audit and feedback. This approach can aid stewardship efforts in the ambulatory care setting particularly with regards to telemedicine.Disclosures Tejal N. Gandhi, MD, Blue Cross Blue Shield of Michigan (Individual(s) Involved: Self): Grant/Research Support Lindsay A. Petty, MD, Nothing to disclose

Knowledge and attitude towards antibiotics use among mothers attending pediatric clinics in king Saud medical city, Riyadh, Saudi Arabia 2021

Background: Upper respiratory tract infections (URTIs) are particularly common in children and are a major source of antibiotic misuse, which leads to antibiotic resistance development. Aims: To assess the Knowledge and Attitude towards antibiotics use among mothers Attending pediatric clinics in King Saud medical city |(KSMC), Riyadh, Saudi Arabia. Materials and Methods: This cross sectional study was conducted in pediatric clinics in KSMC, Riyadh, Saudi Arabia between March 2021 and August 2021. Desired population in this study was mothers of children aged ≤ 14 years Attending pediatric clinics in KSMC, Riyadh, they were selected via a convenient non-probability sampling technique. Data was collected using self-administered questionnaire and analysis was performed using (SPSS). Results: A total of 422 mothers participated in this study. 77.3% of the parents had poor knowledge of the use of antibiotics in children for URTIs, even though the majority of the participants (93.4%) considered physicians as the primary source of information. Only 17.3% of the participants strongly agreed that most of the URTIs are of viral origin and only 12.3% of the participants correctly know that antibiotics have side effects and 39.8% strongly agreed that the inappropriate use of antibiotics reduces their efficacy and drives bacterial resistance. Fever and ear ache were the most common reasons for which parents visited the physician. Additionally, mothers have child with history of chronic disease considered as have good knowledge compared to mothers not have child with history of chronic disease, with significant association (P = 0.007). Conclusion:The relationship between mothers and physicians is trusted, but Saudi mothers are insufficiently informed about antibiotics' use for URTIs, which results in inappropriate attitudes and practices. Educational interventions for both parents and physicians will reduce unnecessary antibiotic use and resistance.

Decisions to use antibiotics for upper respiratory tract infections across China: a large-scale cross-sectional survey among university students

ObjectivesTo investigate the decision-making process of Chinese university students with respect to antibiotic use for upper respiratory tract infections (URTIs).DesignA cross-sectional questionnaire study.SettingThe participants recruited from six universities across all...

Cost of inappropriate antimicrobial use for upper respiratory infection in Japan

BackgroundAntibiotics are often prescribed inappropriately to patients with upper respiratory infection (URI) in ambulatory care settings; however, the economic burden of such prescription has not been quantitatively assessed. Here, we aimed to evaluate the additional cost of antimicrobial prescription for URI at the population level in Japan.MethodsWe conducted a retrospective observational survey using longitudinal claims data between 2013 and 2016 obtained from JMDC Claims Database, which contains data from 5·1 million corporate employees and family members under the age of 65 years. Appropriateness of antibiotic prescription was assessed by a panel of six infectious disease physicians according to ICD-10 code in JMDC Claims Database. Total additional cost of antibiotic prescription for URI at the national level was estimated by weighting of age-structured population data.ResultsThe annual additional cost of inappropriate antibiotic prescription for URI was estimated at 423·6 (95% CI: 416·8–430·5) million USD in 2013, 340·9 (95% CI: 335·7–346·2) million USD in 2014, 349·9 (95% CI: 344·5–355·3) million USD in 2015, and 297·1 (95% CI: 292·4–301·9) million USD in 2016. Three classes of broad-spectrum oral antibiotics (third-generation cephalosporins, macrolides, and fluoroquinolones) accounted for > 90% of the total additional cost.ConclusionsAlthough a decreasing trend was observed, annual additional costs of inappropriate antibiotic prescriptions for URI could be a substantial economic burden in Japan. Appropriately prescribing broad-spectrum oral antibiotics might be an important issue to reduce unnecessary medical costs in Japanese ambulatory care.

Pilot Survey of Knowledge, Attitudes and Perceptions of Hajj Deployed Health Care Workers on Antibiotics and Antibiotic Prescriptions for Upper Respiratory Tract Infections: Results from Two Hajj Seasons.

Antimicrobial resistance (AMR) is a global public health issue. Upper respiratory tract infections (URTIs) are common illnesses during Hajj, for which antibiotics are often inappropriately prescribed. Hajj healthcare workers’ (HCW) knowledge, attitudes and perceptions (KAP) about AMR and antibiotic use for URTIs are not known. We conducted a survey among HCWs during Hajj to explore their KAP regarding antibiotic use for URTIs in pilgrims. Electronic or paper-based surveys were distributed to HCWs during the Hajj in 2016 and 2017. A total of 85 respondents aged 25 to 63 (median 40) years completed the surveys. Most participants were male (78.8%) and were physicians by profession (95.3%). Around 85% and 19% of respondents claimed to have heard about AMR and antimicrobial stewardship programs, respectively, among whom most had obtained their knowledge during their qualification. Implementation of URTI treatment guidelines was very low. In conclusion, HCWs at Hajj have significant knowledge gaps regarding AMR, often do not use standard clinical criteria to diagnose URTIs and display a tendency to prescribe antibiotics for URTIs.

Parental knowledge and practice on antibiotic use for upper respiratory tractinfections in children: a systematic review

Background: Antibiotics are medications used for the treatment of bacterial infections. The misuse of antibiotics can lead to bacterial resistance. Upper respiratory tract infection is a common disease that is mostly caused by viral infections but often treated by antibiotics. The aim of this review was to investigate the level of knowledge and practice of parents on the use of antibiotics for their children in the treatment of upper respiratory tract infection. Methodology: This systematic review involved an online search to obtain the articles related to our subject. We used Google Scholar to search for articles related to the current subject. The search process included using several keywords to obtain all possible articles. Several criteria were set to select articles in this systematic review. Results: Of 40 articles obtained, we included only 12 articles as they fulfilled the inclusion criteria and were published after 2015. The articles were summarized according to the main points: publication year, country of study, number of parents, main findings of knowledge and practice, the percent and level of knowledge and practice, conclusion, and recommendations. Conclusion: There was inadequate knowledge among parents regarding antibiotics used for upper respiratory tract infections in children, which led to inappropriate practice.

Development of a pharmacists’ antibiotic shared decision-making tool for adolescents in upper respiratory tract infections

Inappropriate use of antibiotics for upper respiratory infections is often seen in adolescents. The use of shared decision-making (SDM) tools has been shown to reduce this. Therefore, this study aims to develop an SDM aid for upper respiratory infections in adolescents. A steering committee was set up that consisted of a multidisciplinary team to develop the SDM aid based on the International Patient Decision Aids Standards (IPDAS) process. The aid was developed based on two scenarios: A — request for antibiotics without a valid prescription, and B — request for antibiotics with a prescription. A steering committee reviewed an extensive draft which was sent to 800 pharmacists for further input. Six hundred and eight respondents returned the completed survey. For scenario A, a total of 27 statements were included in the final decision aid. In scenario B, a total of 17 statements were included in the decision aid. The final draft was then reviewed and approved. To the best of our knowledge, this is the first SDM aid developed for antibiotic use among adolescents based on local data. Further work should be performed to promote its use, to ensure positive outcome of antibiotic use in upper respiratory infections.

Bacterial Infections of the Adult Upper Respiratory Tract

Upper respiratory tract infections are the most common maladies experienced by humankind.1 The majority are caused by respiratory viruses. A Dutch case-controlled study of primary care patients with acute respiratory tract infections found that viruses accounted for 58% of cases; rhinovirus was the most common (24%), followed by influenza virus type A (11%) and corona­viruses (7%). Group A streptococcus (GAS) was responsible for 11%, and 3% of patients had mixed infections. Potential pathogens were detected in 30% of control patients who were free of acute respiratory symptoms; rhinovirus was the most common.2 Given the increasing problem of antibiotic resistance and the increasing awareness of the importance of a healthy microbiome, antibiotic use for upper respiratory infections should be reserved for those patients with clear indications for treatment. A recent study of adult outpatient visits in the United States found that respiratory complaints accounted for 150 antibiotic prescriptions per 1,000 population annually, yet the expected “appropriate” rate would be 45.3 In other words, most antibiotic prescriptions for these complaints are unnecessary. Similarly, a study in the United Kingdom found that general practitioners prescribed antibiotics to about half of all patients presenting with an upper respiratory infection, even though most of these infections are viral.4 This review contains 5 figures, 16 tables, and 82 references. Keywords: infection, airway, sinusitis, otitis media, otitis externa, pharyngitis, epiglottitis, abscess

Bacterial Infections of the Adult Upper Respiratory Tract

Upper respiratory tract infections are the most common maladies experienced by humankind.1 The majority are caused by respiratory viruses. A Dutch case-controlled study of primary care patients with acute respiratory tract infections found that viruses accounted for 58% of cases; rhinovirus was the most common (24%), followed by influenza virus type A (11%) and corona­viruses (7%). Group A streptococcus (GAS) was responsible for 11%, and 3% of patients had mixed infections. Potential pathogens were detected in 30% of control patients who were free of acute respiratory symptoms; rhinovirus was the most common.2 Given the increasing problem of antibiotic resistance and the increasing awareness of the importance of a healthy microbiome, antibiotic use for upper respiratory infections should be reserved for those patients with clear indications for treatment. A recent study of adult outpatient visits in the United States found that respiratory complaints accounted for 150 antibiotic prescriptions per 1,000 population annually, yet the expected “appropriate” rate would be 45.3 In other words, most antibiotic prescriptions for these complaints are unnecessary. Similarly, a study in the United Kingdom found that general practitioners prescribed antibiotics to about half of all patients presenting with an upper respiratory infection, even though most of these infections are viral.4 This review contains 5 figures, 16 tables, and 82 references. Keywords: infection, airway, sinusitis, otitis media, otitis externa, pharyngitis, epiglottitis, abscess

Knowledge of Antibiotic Use in College Students: A Quality Improvement Project

Aim: To evaluate college students' knowledge, attitudes, and beliefs about antibiotic use for simple viral infections, as well as determine if knowledge could be improved through an educational intervention and examine impacts on overall patient satisfaction.Background: Antibiotic resistance is a growing problem. College-aged students are at an increased risk for simple respiratory infections due to their close living conditions and poor knowledge of appropriate antibiotic use (Smith, Rigassio-Radler, Denmark, Haley, &amp; Touger-Decker, 2012; Turner &amp; Keller, 2015).Methods: Students (N = 44) age 19-25 seen at the college health center of a small, private Nebraska university presenting with symptoms of an upper respiratory infection (URI) were given a survey prior to seeing the healthcare provider. During the visit, providers reviewed an educational handout discussing appropriate antibiotic use for URIs and then gave the student a post-survey to complete.Results: Students' Basic Knowledge of antibiotics improved, p = .1, Cohen's d = 0.41 as a result of the educational intervention, while changes in knowledge about Efficacy and Provider trust was mixed. Knowledge of correct use/misuse was high at pre, M = 1.95 and post M = 1.93.Conclusions: College-aged students benefit from additional education about antibiotics. Based on this project's findings, educational handouts have the potential to improve knowledge regarding antibiotics.