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Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study

BACKGROUND: Little is known about the pattern and appropriateness of antibiotic prescriptions in patients with acute respiratory tract infections (ARTIs). OBJECTIVE: Describe the antibiotics used to treat ARTIs in Tunisian primary care offices and emergency departments (EDs), and assess the appropri...

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Autores principales: Bel Haj Ali, Khaoula, Sekma, Adel, Messous, Selma, Trabelsi, Imen, Ben Youssef, Jalel, Maghraoui, Hamida, Razgallah, Rabie, walha, Adel, Grissa, Mohamed Habib, Beltaief, Kaouthar, Mezgar, Zied, Coubantini, Ahmed, Bouida, Wahid, Msolli, Mohamed Amine, Boukef, Riadh, Boubaker, Hamdi, Nouira, Semir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9682766/
https://www.ncbi.nlm.nih.gov/pubmed/36418965
http://dx.doi.org/10.1186/s12875-022-01904-7
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author Bel Haj Ali, Khaoula
Sekma, Adel
Messous, Selma
Trabelsi, Imen
Ben Youssef, Jalel
Maghraoui, Hamida
Razgallah, Rabie
walha, Adel
Grissa, Mohamed Habib
Beltaief, Kaouthar
Mezgar, Zied
Coubantini, Ahmed
Bouida, Wahid
Msolli, Mohamed Amine
Boukef, Riadh
Boubaker, Hamdi
Nouira, Semir
author_facet Bel Haj Ali, Khaoula
Sekma, Adel
Messous, Selma
Trabelsi, Imen
Ben Youssef, Jalel
Maghraoui, Hamida
Razgallah, Rabie
walha, Adel
Grissa, Mohamed Habib
Beltaief, Kaouthar
Mezgar, Zied
Coubantini, Ahmed
Bouida, Wahid
Msolli, Mohamed Amine
Boukef, Riadh
Boubaker, Hamdi
Nouira, Semir
author_sort Bel Haj Ali, Khaoula
collection PubMed
description BACKGROUND: Little is known about the pattern and appropriateness of antibiotic prescriptions in patients with acute respiratory tract infections (ARTIs). OBJECTIVE: Describe the antibiotics used to treat ARTIs in Tunisian primary care offices and emergency departments (EDs), and assess the appropriateness of their use. METHODS: It was a prospective multicenter cross-sectional observational clinical study conducted at 63 primary care offices and 6 EDS during a period of 8 months. Appropriateness of antibiotic prescription was evaluated by trained physicians using the medication appropriateness index (MAI). The MAI ratings generated a weighted score of 0 to 18 with higher scores indicating low appropriateness. The study was conducted in accordance with the Declaration of Helsinki and national and institutional standards. The study was approved by the Ethics committee of Monastir Medical Faculty. RESULTS: From the 12,880 patients screened we included 9886 patients. The mean age was 47.4, and 55.4% were men. The most frequent diagnosis of ARTI was were acute bronchitis (45.3%), COPD exacerbation (16.3%), tonsillitis (14.6%), rhinopharyngitis (12.2%) and sinusitis (11.5%). The most prescribed classes of antibiotics were penicillins (58.3%), fluoroquinolones (17.6%), and macrolides (16.9%). Antibiotic therapy was inappropriate in 75.5% of patients of whom 65.2% had bronchitis. 65% of patients had one or more antibiotic prescribing inappropriateness criteria as assessed by the MAI. The most frequently rated criteria were with expensiveness (75.8%) and indication (40%). Amoxicillin-clavulanic acid and levofloxacin were the most inappropriately prescribed antibiotics. History of cardiac ischemia ([OR] 3.66; 95% [CI] 2.17–10.26; p < 0.001), asthma ([OR] 3.29, 95% [CI] 1.77–6.13; p < 0.001), diabetes ([OR] 2.09, 95% [CI] 1.54–2.97; p = 0.003), history of COPD ([OR] 1.75, 95% [CI] 1.43–2.15; p < 0.001) and age > 65 years (Odds Ratio [OR] 1.35, 95% confidence interval [CI] 1.16–1.58; p < 0.001) were associated with a higher likelihood of inappropriate prescribing. CONCLUSION: Our findings indicate a high inappropriate use of antibiotics in ARTIs treated in in primary care and EDs. This was mostly related to antibiotic prescription in acute bronchitis and overuse of expensive broad spectrum antibiotics. Future interventions to improve antibiotic prescribing in primary care and EDs is needed. TRIAL REGISTRATION: the trial is registered at Clinicaltrials.gov registry (NCT04482231).
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spelling pubmed-96827662022-11-24 Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study Bel Haj Ali, Khaoula Sekma, Adel Messous, Selma Trabelsi, Imen Ben Youssef, Jalel Maghraoui, Hamida Razgallah, Rabie walha, Adel Grissa, Mohamed Habib Beltaief, Kaouthar Mezgar, Zied Coubantini, Ahmed Bouida, Wahid Msolli, Mohamed Amine Boukef, Riadh Boubaker, Hamdi Nouira, Semir BMC Prim Care Research BACKGROUND: Little is known about the pattern and appropriateness of antibiotic prescriptions in patients with acute respiratory tract infections (ARTIs). OBJECTIVE: Describe the antibiotics used to treat ARTIs in Tunisian primary care offices and emergency departments (EDs), and assess the appropriateness of their use. METHODS: It was a prospective multicenter cross-sectional observational clinical study conducted at 63 primary care offices and 6 EDS during a period of 8 months. Appropriateness of antibiotic prescription was evaluated by trained physicians using the medication appropriateness index (MAI). The MAI ratings generated a weighted score of 0 to 18 with higher scores indicating low appropriateness. The study was conducted in accordance with the Declaration of Helsinki and national and institutional standards. The study was approved by the Ethics committee of Monastir Medical Faculty. RESULTS: From the 12,880 patients screened we included 9886 patients. The mean age was 47.4, and 55.4% were men. The most frequent diagnosis of ARTI was were acute bronchitis (45.3%), COPD exacerbation (16.3%), tonsillitis (14.6%), rhinopharyngitis (12.2%) and sinusitis (11.5%). The most prescribed classes of antibiotics were penicillins (58.3%), fluoroquinolones (17.6%), and macrolides (16.9%). Antibiotic therapy was inappropriate in 75.5% of patients of whom 65.2% had bronchitis. 65% of patients had one or more antibiotic prescribing inappropriateness criteria as assessed by the MAI. The most frequently rated criteria were with expensiveness (75.8%) and indication (40%). Amoxicillin-clavulanic acid and levofloxacin were the most inappropriately prescribed antibiotics. History of cardiac ischemia ([OR] 3.66; 95% [CI] 2.17–10.26; p < 0.001), asthma ([OR] 3.29, 95% [CI] 1.77–6.13; p < 0.001), diabetes ([OR] 2.09, 95% [CI] 1.54–2.97; p = 0.003), history of COPD ([OR] 1.75, 95% [CI] 1.43–2.15; p < 0.001) and age > 65 years (Odds Ratio [OR] 1.35, 95% confidence interval [CI] 1.16–1.58; p < 0.001) were associated with a higher likelihood of inappropriate prescribing. CONCLUSION: Our findings indicate a high inappropriate use of antibiotics in ARTIs treated in in primary care and EDs. This was mostly related to antibiotic prescription in acute bronchitis and overuse of expensive broad spectrum antibiotics. Future interventions to improve antibiotic prescribing in primary care and EDs is needed. TRIAL REGISTRATION: the trial is registered at Clinicaltrials.gov registry (NCT04482231). BioMed Central 2022-11-22 /pmc/articles/PMC9682766/ /pubmed/36418965 http://dx.doi.org/10.1186/s12875-022-01904-7 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Bel Haj Ali, Khaoula
Sekma, Adel
Messous, Selma
Trabelsi, Imen
Ben Youssef, Jalel
Maghraoui, Hamida
Razgallah, Rabie
walha, Adel
Grissa, Mohamed Habib
Beltaief, Kaouthar
Mezgar, Zied
Coubantini, Ahmed
Bouida, Wahid
Msolli, Mohamed Amine
Boukef, Riadh
Boubaker, Hamdi
Nouira, Semir
Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study
title Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study
title_full Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study
title_fullStr Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study
title_full_unstemmed Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study
title_short Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study
title_sort appropriateness of antibiotic treatment of acute respiratory tract infections in tunisian primary care and emergency departments: a multicenter cross-sectional study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9682766/
https://www.ncbi.nlm.nih.gov/pubmed/36418965
http://dx.doi.org/10.1186/s12875-022-01904-7
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