Implementing CDC framework reduces antibiotic prescribing for uncomplicated ARIs
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Implementing a CDC framework for outpatient stewardship reduced hospitalizations and antibiotic prescribing for uncomplicated acute upper respiratory tract infections at 10 sites, according to a recent study in Clinical Infectious Diseases.
“Acute upper respiratory tract infections (ARI) are one of the most common reasons patients seek care. Most of these infections are caused by viruses and antibiotics are not indicated in the majority of cases,” Karl Madaras-Kelly, PharmD, MPH, professor of pharmacy practice at Idaho State University’s College of Pharmacy and a pharmacist at the Boise Veterans Affairs Medical Center Pharmacy Service, told Healio.
“Despite numerous recommendations to curtail the prescription of antibiotics for these conditions, clinicians continue to overprescribe antibiotics for these conditions,” Madaras-Kelly said. “Clinicians generally understand that antibiotics are not indicated for the majority of cases but continue to prescribe at high rates due to perception of prescribing pressures and fear that patients may not get better without them.”
In a quasi-experimental controlled study, Madaras-Kelly and colleagues assessed the effects of an intervention ⎼⎼ the introduction of the CDC’s Core Elements of Outpatient Antibiotic Stewardship ⎼⎼ targeting antibiotic prescription for uncomplicated ARI. According to the study, outcomes included per-visit antibiotic prescribing, treatment appropriateness, potential benefits and complications of reduced antibiotic treatment and change in ARI diagnoses over a 3-year pre-implementation and one year post-implementation period.
The study revealed that from 2014 to 2019, there were 16,712 and 51,275 patient-visits in 10 intervention and 40 control sites, respectively.
According to researchers, antibiotic prescribing rates pre- post-implementation in intervention sites were 59.7% and 41.5%, respectively, while in control sites they were 73.5% and 67.2%, respectively (P < .001). Additionally, the study showed that the intervention site pre- post-implementation odds ratio to receive appropriate therapy increased (OR = 1.67; 95% CI, 1.31-2.14) while remaining unchanged at the control sites (OR = 1.04; 95% CI, 0.91-1.19).
The study also showed that there was no difference in ARI-related return visits post-implementation (1.3% vs. -2.0%; P = .76) but all-cause hospitalization was lower at intervention sites (-0.5% vs. -0.2%; P = .02].
“Providing feedback on physician antibiotic prescribing rates relative to peers reduced antibiotic prescribing for conditions where antibiotics are rarely indicated,” Madaras-Kelly said. “The practice was safe and may be associated with improved outcomes. Program administrators should recognize that similar interventions may also impact diagnostic coding practices.”
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