Defining appropriate antibiotic prescribing in primary care: A modified Delphi panel approach

Area of Science:

• Infectious Diseases
• Antimicrobial Stewardship
• Public Health

Background:

• Antimicrobial overuse is a significant driver of antimicrobial resistance.
• The ambulatory setting accounts for over 90% of antibiotic dispensing.
• There is a lack of established Canadian benchmarks for appropriate outpatient antibiotic use.

Purpose of the Study:

• To define expected appropriate outpatient antibiotic prescribing rates.
• To establish benchmarks for three age groups: <2, 2-18, and >18 years.
• To inform antimicrobial stewardship initiatives in community settings.

Main Methods:

• A modified Delphi method was employed.
• A multidisciplinary panel of experts (physicians and pharmacists) participated.
• An online questionnaire and in-person meetings were used to achieve consensus on 23 clinical conditions.

Main Results:

• Consensus was reached on appropriate prescribing rates for various conditions, with rates varying by condition and age group.
• High consensus rates (100%) were achieved for conditions like pneumonia and pyelonephritis.
• Lower consensus rates were observed for conditions like bronchitis (5-8%) and common cold (0%).

Conclusions:

• Expert consensus provides defined levels for appropriate antibiotic prescribing in outpatient settings.
• These benchmarks can guide antimicrobial stewardship programs.
• The findings facilitate the investigation of inappropriate antibiotic use and the setting of optimization targets.