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

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy Pub Date : 2024-03-18 DOI:10.1002/clt2.12345

Anne-Lotte Redel, Wojciech Feleszko, Alessandra Arcolaci, Francesca Cefaloni, Marina Atanaskovic-Markovic, Gert-Jan Braunstahl, Cristina Boccabella, Matteo Bonini, Aspasia Karavelia, Eefje Louwers, Norbert Mülleneisen, Liam O'Mahony, Laura Pini, Anna Rapiejko, Esmeralda Shehu, Milena Sokolowska, Eva Untersmayr, Gerdien Tramper-Stranders, EAACI Task Force on Conscious and Rational use of Antibiotics in Allergic Diseases

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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.

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关于哮喘急性加重期抗生素处方做法的调查研究：欧洲过敏与临床免疫学学会特别工作组报告。

导言：指南建议使用支气管扩张剂联合吸入和/或全身皮质类固醇治疗哮喘加重（AAE）。目的：调查AAE中的抗生素处方率，并探索这些做法的可能决定因素：方法：为确定AAE中的抗生素处方率以及处方做法的影响因素，制作了一份数字调查表。我们通过群发邮件以及荷兰、意大利、希腊和波兰的地区/国家协会向欧洲过敏与临床免疫学学会（EAACI）会员发放了调查问卷。此外，我们还检索了当地的抗生素处方率：共有 252 位参与者完成了调查。受访者表示，AAE 缺乏抗生素处方指南。本研究的抗生素处方率中位数为 19% [IQR：0%-40%]，4 个专业之间存在显著差异：儿科医生 0% [IQR：0%-37%]，肺科医生 25% [IQR：10%-50%]，全科医生 25% [IQR：0%-50%]，过敏科医生 17% [IQR：0%-33%]）（p = 0.046）。71.4%的患者在处方前进行了额外的诊断测试，处方中最常见的抗生素类别是大环内酯类（46.0%）和青霉素类（42.9%）。医护人员开具抗生素处方的重要临床因素是痰液变色/化脓、听诊时肺部听诊异常、发热和存在合并症：在 19% 的 AAE 患者中，不同亚专科处方的抗生素种类繁多。本研究强调了制定循证指南的紧迫性，旨在为AAE患者开出更合理的抗生素处方。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Translational Allergy Immunology and Microbiology-Immunology

CiteScore

7.50

自引率

4.50%

发文量

117

审稿时长

12 weeks

期刊介绍： Clinical and Translational Allergy, one of several journals in the portfolio of the European Academy of Allergy and Clinical Immunology, provides a platform for the dissemination of allergy research and reviews, as well as EAACI position papers, task force reports and guidelines, amongst an international scientific audience. Clinical and Translational Allergy accepts clinical and translational research in the following areas and other related topics: asthma, rhinitis, rhinosinusitis, drug hypersensitivity, allergic conjunctivitis, allergic skin diseases, atopic eczema, urticaria, angioedema, venom hypersensitivity, anaphylaxis, food allergy, immunotherapy, immune modulators and biologics, animal models of allergic disease, immune mechanisms, or any other topic related to allergic disease.