title: Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections.
abstract: Antibiotic use is a modifiable driver of antibiotic resistance. In many circumstances, antibiotic use is overly broad or unnecessary. We systematically assessed factors associated with antibiotic prescribing for respiratory tract infections (RTI). Studies were included if they used actual (not self-reported or intended) prescribing data, assessed factors associated with antibiotic prescribing for RTIs, and performed multivariable analysis of associations. We searched Medline, Embase, and International Pharmaceutical Abstracts using keyword and MeSH (medical subject headings) search terms. Two authors reviewed each abstract and independently appraised all included texts. Data on factors affecting antibiotic prescribing were extracted. Our searches retrieved a total of 2,848 abstracts, with 97 included in full-text review and 28 meeting full inclusion criteria. Compared to other factors, diagnosis of acute bronchitis was associated with increased antibiotic prescribing (range of adjusted odds ratios [aOR], 1.56 to 15.9). Features on physical exam, such as fever, purulent sputum, abnormal respiratory exam, and tonsillar exudate, were also associated with higher odds of antibiotic prescribing. Patient desire for an antibiotic was not associated or was modestly associated with prescription (range of aORs, 0.61 to 9.87), in contrast to physician perception of patient desire for antibiotics, which showed a stronger association (range of aORs, 2.11 to 23.3). Physician's perception of patient desire for antibiotics was strongly associated with antibiotic prescribing. Antimicrobial stewardship programs should continue to expand in the outpatient setting and should emphasize clear and direct communication between patients and physicians, as well as signs and symptoms that do and do not predict bacterial etiology of upper respiratory tract infections.
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada rachel.mckay@alumni.ubc.ca.
authors.forename: Rachel
authors.identifier: 0000-0002-3114-9196
authors.initials: R
authors.lastname: McKay
authors.affiliation: Division of Infectious Diseases, University of British Columbia, Vancouver, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: Mah
authors.affiliation: Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Michael R
authors.identifier: 0000-0002-5637-6053
authors.initials: MR
authors.lastname: Law
authors.affiliation: Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Kimberlyn
authors.initials: K
authors.lastname: McGrail
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada Division of Infectious Diseases, University of British Columbia, Vancouver, Canada.
authors.forename: David M
authors.initials: DM
authors.lastname: Patrick
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001991:Bronchitis / Q000188:drug therapy; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents