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Inappropriateness and variability of antibiotic prescription among French office-based physicians
D Guillemot1, C Carbon, F Vauzelle-Kervroëdan
1Institut National de la Santé et de la Recherche Médicale U21, Villejuif, France.
Objective:
To describe oral antibiotic prescription in the community.
Design:
Audit of anti-infective prescribing in office-based medical practice.
Setting:
Center of France, in the Loiret, a 600,000 inhabitant administrative division.
Main Outcome Measures:
Clinical hypothesis and antimicrobial drugs used as well as daily doses and durations of treatment.
Results:
Respiratory tract infections with a presumed viral etiology accounted for 36% of prescriptions. In children, a high percentage of antibiotic prescriptions were underdosed as compared to clinical recommendations, particularly in acute otitis media. The variability of the daily dose was high, with coefficients of variation over 40% in acute otitis media or acute tracheobronchitis. Whatever the clinical hypothesis, the duration of treatment was close to 8 days. In acute otitis media, the coefficient of variation was 14%, the lowest for all diagnoses.
Conclusion:
Our investigation identified two main areas for improving antimicrobial drug prescribing: (1) reduction of useless prescriptions in respiratory tract infections with a presumed viral etiology, and (2) increasing the prescribed daily dose of antimicrobials to the recommended levels.
Insights
Community antibiotic prescribing shows significant issues, with many prescriptions for viral infections and underdosing in children, particularly for acute otitis media. Improving antibiotic use requires reducing unnecessary prescriptions and increasing prescribed doses.
Area of Science:
- Pharmacology
- Infectious Diseases
- Public Health
Background:
- Oral antibiotic prescriptions are common in community settings.
- Antimicrobial stewardship is crucial for combating resistance and optimizing patient outcomes.
Purpose of the Study:
- To characterize oral antibiotic prescribing patterns in community medical practices.
- To identify areas for improvement in antimicrobial drug utilization.
Main Methods:
- An audit of anti-infective prescribing was conducted in office-based medical practices in the Loiret region of France.
- Data collected included clinical indications, antimicrobial agents, daily doses, and treatment durations.
Main Results:
- 36% of antibiotic prescriptions were for respiratory tract infections with presumed viral causes.
- A significant proportion of pediatric antibiotic prescriptions, especially for acute otitis media, were underdosed compared to guidelines.
- High variability in daily dosing was observed (CV >40% for acute otitis media and tracheobronchitis).
- Treatment durations were consistently around 8 days, with low variability for acute otitis media (CV 14%).
Conclusions:
- Two key areas for enhancing antimicrobial prescribing were identified: reducing unnecessary prescriptions for viral respiratory infections and increasing prescribed daily doses to recommended levels.
- Optimizing antibiotic use can improve treatment efficacy and mitigate the development of antimicrobial resistance.