What influences the prescribing of antibiotics in lower respiratory tract infection?

• Main Author: Allman, Mark
• Other Authors: Moss, Stephen
• Published: University of Bath 2014
• Subjects: 615.3
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.687300

Antibiotics are widely prescribed for patients with lower respiratory tract infection (LRTI) yet only a minority have a pneumonia which responds to antibiotic treatment. Unwarranted prescribing of antibiotics is associated with several problems aside from the financial implications of unnecessary treatment: increased incidence of hospital-acquired infections, including MRSA and Clostridium difficile and the problem of antibiotic resistance. The aim of this study was to investigate the influence of the history and examination findings on antibiotic prescribing where LRTI is the principal diagnosis, and to explore the attitudes towards antibiotic prescribing through an understanding of the clinician and patient experience. A mixed methodology study of adult hospitalised patients was employed, with a case series for the quantitative arm and thematic analysis employed for the qualitative arm of the research. Data was collected from patients’ medical notes using a coding matrix developed as part of a pilot study. Doctors were invited to participate in interviews to discuss the reasons for prescribing antibiotics in respiratory tract infection and a group of patients were interviewed for their views on antibiotics. 153 participants were enrolled into the quantitative arm and a further 10 in the qualitative arm. The data indicate that the diagnosis of LRTI and prescription of antibiotics is made on the recorded presence of a very small number of symptoms and signs, with 91% having shortness of breath, 77% having purulent sputum and 75% having a respiratory rate >20/minute. The parameters used to determine a bacterial cause for disease are often non-specific and can lead to inappropriate antibiotic prescribing. Antibiotic use must be targeted to those in whom there is benefit. To enable clinicians to do this they require access to pathology and x ray and these must be supported by expert input. In addition, rapid, reliable diagnostic testing for bacterial infections can assist.