Respiratory infection antibiotic guidance often ignored

Sep 2 2013

Researchers from the USA say that more must be done to improve adherence to guidelines for antibiotic prescriptions for upper respiratory tract infections (URTIs), sinusitis, and pharyngitis.

Their study showed that only 57% of patients presenting to an internal medicine practice over a 4-year period received guideline-concordant treatment. And, while attending physicians varied significantly in their adherence to guidelines for URTI and pharyngitis, they were consistently less likely to adhere to guidelines regarding pharyngitis in younger patients.

The team, led by Richard Alweis (The Reading Hospital and Medical Center, West Reading, Pennsylvania), analyzed data on 1548 patients seen between 2008 and 2012.

They observed “disappointing” guideline adherence for all three conditions, at 79% for URTI, 42% for acute sinusitis, and 24% for pharyngitis.

In multivariate analysis, age was predictive for guideline adherence in pharyngitis, with a mean age of 54 years in patients receiving concordant treatment compared with 41 years in those who did not. And in URTI, provider significantly predicted adherence, which ranged from 50.0% to 98.3% for different attending physicians. However, there were no variables significantly associated with treatment adherence for sinusitis.

The authors were surprised to observe no effect of having a learner present on attending physician guideline adherence, something which they sought to investigate after recent reviews found that patients at teaching hospitals experienced better outcomes than those at non-teaching hospitals.

The researchers say that the reasons for their findings are not clear. They suggest that poor adherence to guidelines could be due to lack of familiarity with them among physicians, lack of time, and a potential overemphasis on meeting patients’ expectations.

Writing in the Journal of Community Hospital Internal Medicine Perspectives, Alweis and colleagues say that the results highlight the need for strategies to improve guideline adherence, which could include education for both physicians and patients.

“Given the complications of unnecessary antibiotic therapy are significant, further study is needed to determine the best modality to assist physicians in adhering to nationally recognized guidelines,” they conclude.

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