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Improving diagnostic antimicrobial stewardship in respiratory tract infections: a protocol for a scoping review
Sajal K Saha1,2, Shukla Promite3, Carly L Botheras4,5
1School of Medicine, Deakin University, Geelong, Victoria, Australia sajal.saha@deakin.edu.au.
Introduction:
Diagnostic uncertainty regarding the cause of respiratory tract infections (RTIs) multiplies the problem of unnecessary use of antibiotics and antimicrobial resistance in primary care. Point-of-care testing (POCT) programmes have been recognised as a potential stewardship strategy to optimise antimicrobial use in primary care. There is a need for greater understanding of community pharmacy-based POCT programmes in reducing the unnecessary use of antimicrobials in patients with RTIs. This review systematically maps out evidence around the effectiveness, feasibility and implementation challenges of POCT programmes in community pharmacy to improve safe antimicrobial use in RTIs.
Methods And Analysis:
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and the Arksey and O'Malley methodology framework will guide the reporting of this review. We will systematically review studies with either randomised controlled trial, non-randomised controlled trial, before-after study, observational study or pilot feasibility study design. Medline, Emcare, PubMed, Health Technology Assessment, Cochrane Central Register of Controlled Trials and Google Scholar databases will be used to search for articles. Three reviewers will independently screen, review and select studies with POCT programmes involving community pharmacists for antimicrobial stewardship in RTIs. Summary statistics and random effects model, if data permit, will be used to summarise the effectiveness, feasibility and cost-effectiveness of the POCT programme. The Consolidated Framework for Implementation Research will capture POCT implementation drivers.
Ethics And Dissemination:
This review study does not require research ethics approval. Findings will be disseminated through national and international conferences, seminars and publication in a peer-reviewed journal.
Insights
Point-of-care testing (POCT) in community pharmacies can optimize antibiotic use for respiratory tract infections (RTIs). This review examines POCT program effectiveness, feasibility, and challenges to reduce unnecessary antimicrobial prescriptions.
Area of Science:
- Public Health and Pharmacy Practice
- Infectious Diseases and Antimicrobial Stewardship
Background:
- Diagnostic uncertainty in respiratory tract infections (RTIs) contributes to antibiotic overuse and antimicrobial resistance in primary care.
- Point-of-care testing (POCT) is a recognized strategy to improve antimicrobial stewardship.
- Community pharmacy-based POCT programs require further understanding regarding their role in optimizing antimicrobial use for RTIs.
Purpose of the Study:
- To systematically map the evidence on the effectiveness, feasibility, and implementation challenges of POCT programs in community pharmacies.
- To assess the potential of community pharmacy-based POCT to improve safe antimicrobial use in patients with RTIs.
Main Methods:
- A systematic scoping review guided by the PRISMA extension for Scoping Reviews and the Arksey and O'Malley framework.
- Inclusion of studies with various designs (RCTs, non-RCTs, before-after, observational, pilot feasibility).
- Searches across multiple databases (Medline, Emcare, PubMed, HTA, Cochrane, Google Scholar) with independent screening by three reviewers.
- Analysis using summary statistics and random effects models where data permit; Consolidated Framework for Implementation Research for drivers.
Main Results:
- This section will present synthesized findings on the effectiveness, feasibility, and cost-effectiveness of POCT programs in community pharmacies for RTIs.
- Identification of key implementation drivers and challenges based on the Consolidated Framework for Implementation Research.
Conclusions:
- POCT in community pharmacies shows promise as a strategy to enhance antimicrobial stewardship for RTIs.
- Further research and evidence synthesis are needed to fully understand and implement these programs effectively.
- Dissemination of findings will occur through conferences and peer-reviewed publications.
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