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. 2024 Mar;14(3):e12345.
doi: 10.1002/clt2.12345.

A survey study on antibiotic prescription practices for acute asthma exacerbations: An European academy of allergy and clinical immunology task force report

Anne-Lotte Redel  1   2 , Wojciech Feleszko  3 , Alessandra Arcolaci  4 , Francesca Cefaloni  5 , Marina Atanaskovic-Markovic  6 , Gert-Jan Braunstahl  1   2 , Cristina Boccabella  7 , Matteo Bonini  8   9 , Aspasia Karavelia  10 , Eefje Louwers  11 , Norbert Mülleneisen  12 , Liam O'Mahony  13 , Laura Pini  14 , Anna Rapiejko  3 , Esmeralda Shehu  15 , Milena Sokolowska  16 , Eva Untersmayr  17 , Gerdien Tramper-Stranders  2   18 ; EAACI Task Force on Conscious and Rational use of Antibiotics in Allergic Diseases
Affiliations

A survey study on antibiotic prescription practices for acute asthma exacerbations: An European academy of allergy and clinical immunology task force report

Anne-Lotte Redel et al. Clin Transl Allergy. 2024 Mar.

Abstract

Introduction: Guidelines recommend treating asthma exacerbations (AAEs) with bronchodilators combined with inhaled and/or systemic corticosteroids. Indications for antibiotic prescriptions for AAEs are usually not incorporated although the literature shows antibiotics are frequently prescribed.

Aim: To investigate the antibiotic prescription rates in AAEs and explore the possible determining factors of those practices.

Methods: A digital survey was created to determine the antibiotic prescription rates in AAEs and the influencing factors for the prescription practices. The survey was distributed among European academy of allergy and clinical immunology (EAACI) members by mass emailing and through regional/national societies in the Netherlands, Italy, Greece, and Poland. Furthermore, we retrieved local antibiotic prescription rates.

Results: In total, 252 participants completed the survey. Respondents stated that there is a lack of guidelines to prescribe antibiotics in AAEs. The median antibiotic prescription rate in this study was 19% [IQR: 0%-40%] and was significantly different between 4 professions: paediatrics 0% [IQR: 0%-37%], pulmonologists 25% [IQR: 10%-50%], general practitioners 25% [IQR: 0%-50%], and allergologists 17% [IQR: 0%-33%]) (p = 0.046). Additional diagnostic tests were performed in 71.4% of patients before prescription and the most common antibiotic classes prescribed were macrolides (46.0%) and penicillin (42.9%). Important clinical factors for health care providers to prescribe antibiotics were colorised/purulent sputum, abnormal lung sounds during auscultation, fever, and presence of comorbidities.

Conclusion: In 19% of patients with AAEs, antibiotics were prescribed in various classes with a broad range among different subspecialities. This study stresses the urgency to compose evidence-based guidelines to aim for more rational antibiotic prescriptions for AAE.

Keywords: antibiotics; asthma; exacerbation; survey.

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Conflict of interest statement

None of the authors of this survey study report any conflicts of interest related to this study.

Figures

FIGURE 1
FIGURE 1
Proportion antibiotic prescriptions in acute asthma exacerbations for the international survey (EAACI) and the different national surveys, presented as boxplots with a median and IQR. The sample size of the AAE is presented. Only participants who diagnosed an AAE are included. AAE, acute asthma exacerbation.
FIGURE 2
FIGURE 2
Participants' estimations about the antibiotic prescription practices compared with their colleagues. Data based on the total of the international and national surveys.
FIGURE 3
FIGURE 3
The most common prescribed antibiotics in AAE based on the first choice of prescriber, divided by international survey (presented as EAACI) and the different national surveys. The percentages were calculated as the percentage of the total completed questionnaires per type of questionnaire. None = participants who did not prescribe antibiotics in AAEs. AAE, acute asthma exacerbation.
FIGURE 4
FIGURE 4
Proportion antibiotic prescriptions in AAEs per profession. Proportions are illustrated as boxplots, including the median and IQR. Only health care providers who diagnosed AAE were included. AAE, acute asthma exacerbation.
See this image and copyright information in PMC

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