Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr;28(2):72-83.
doi: 10.21315/mjms2021.28.2.7. Epub 2021 Apr 21.

Patient Factors in Inappropriate Antibiotic Prescribing for Upper Respiratory Tract Infection in the Emergency Department

Azmi Ahmad  1 , Junainah Nor  1 , Ariff Arithra Abdullah  1 , Tuan Hairulnizam Tuan Kamauzaman  1 , Mohd Boniami Yazid  1
Affiliations

Patient Factors in Inappropriate Antibiotic Prescribing for Upper Respiratory Tract Infection in the Emergency Department

Azmi Ahmad et al. Malays J Med Sci. 2021 Apr.

Abstract

Background: Emergency departments (EDs) are frequently misused for non-emergency cases such as upper respiratory tract infections (URTIs). Flooding of these cases may contribute to inappropriate antibiotic prescribing. The aim of this study was to determine the patient factors associated with inappropriate antibiotic prescribing for URTIs in the EDs.

Methods: This cross-sectional study involved patients over age 3 years old who presented with URTI to the green zone of the ED of a tertiary hospital on the east coast of Malaysia in 2018-2019. Convenient sampling was done. The patients were categorised into two groups according to their McIsaac scores: positive (≥ 2) or negative (< 2). Antibiotics given to the negative McIsaac group were considered inappropriate.

Results: A total of 261 cases were included - 127 with positive and 134 with negative McIsaac scores. The most common symptoms were fever and cough. About 29% had inappropriate antibiotic prescribing with a high rate for amoxycillin. Duration of symptoms of one day or less (OR 18.5; 95% CI: 1.65, 207.10; P = 0.018), presence of chills (OR 4.36; 95% CI: 1.13, 16.88; P = 0.033) and diagnosis of acute tonsillitis (OR 5.26; 95% CI: 1.76, 15.72; P = 0.003) were significantly associated with inappropriate antibiotic prescription.

Conclusion: Factors influencing inappropriate antibiotic prescribing should be pointed out to emergency doctors to reduce its incidence.

Keywords: antibiotic prescribing; emergency department; respiratory tract infections.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest The authors declare that there was no conflict of interests to the study, authorship and/ or publication of this article.

Figures

Figure 1
Figure 1
McIsaac scoring management Note: RADT = rapid antigen detection test
Figure 2
Figure 2
Patient flow diagram
See this image and copyright information in PMC

References

    1. Donnelly JP, Baddley JW, Wang HE. Antibiotic utilization for respiratory tract infection in U.S. emergency departments. Antimicrob Agents Chemother. 2014;58(3):1451–1472. doi: 10.1128/AAC.02039-13. - DOI - PMC - PubMed
    1. Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM, Jr, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA. 2016;315(17):1864–1873. doi: 10.1001/jama.2016.4151. - DOI - PubMed
    1. Lim Y, Sivasampu S, Hwong A, Sim B, Chadrasekaran S. Prescribing patterns and factors influencing the choice of antibiotics in upper respiratory tract infection in Malaysia. Kuala Lumpur, Malaysia: Clinical Research Center, Ministry of Health Malaysia; 2012. pp. 1–2.
    1. Fine AM, Nizet V, Mandl KD. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch Intern Med. 2012;172(11):847–852. doi: 10.1001/archinternmed.2012.950. - DOI - PMC - PubMed
    1. Palla AH, Khan RA, Gilani AH, Marra F. Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study. BMC Pulm Med. 2012;12(24):70. doi: 10.1186/1471-2466-12-70. - DOI - PMC - PubMed

LinkOut - more resources