Cochrane for Clinicians

Putting Evidence into Practice

Interventions to Facilitate Shared Decision Making to Address Antibiotic Use for Acute Respiratory Tract Infections in Primary Care

 

Am Fam Physician. 2017 Jan 1;95(1):11-12.

Author disclosure: No relevant financial affiliations.

Clinical Question

Do interventions that aim to facilitate shared decision making reduce the prescribing of antibiotics for acute respiratory tract infections in primary care?

Evidence-Based Answer

Interventions to facilitate shared decision making reduce the prescribing of antibiotics for acute respiratory tract infections in the short term (within six weeks of the consultation) without increasing return visits or decreasing patient satisfaction (number needed to treat [NNT] = 6).1 (Strength of Recommendation: A, based on consistent, good-quality, patient-oriented evidence.)

Practice Pointers

Multiple systematic reviews have shown that antibiotics prescribed for acute respiratory tract infections have minimal benefit because these are predominantly viral infections.2,3 According to the Centers for Disease Control and Prevention, more than one-half of antibiotic prescriptions in outpatient settings are inappropriately written for viral infections, contributing to resistant bacteria causing more than 2 million illnesses in the United States each year.4,5 Shared decision making is a process by which the physician and patient share information including risks, benefits, the best available evidence, and personal values, ultimately reaching agreement on a plan of action.6 This Cochrane review evaluated whether interventions educating physicians on shared decision making for acute respiratory tract infections reduce antibiotic prescribing for these infections in primary care.1 For the purposes of this review, respiratory tract infections included acute cough, rhinosinusitis, pharyngitis, tonsillitis, laryngitis, otitis media, bronchitis, exacerbated chronic obstructive pulmonary disease, and influenza.

This Cochrane review included approximately 492,000 patients in nine randomized trials and one follow-up of an original trial.1 Studies varied by the specific type of intervention and number of study arms. All interventions involved educating physicians about shared decision making

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Coxeter P, Del Mar CB, McGregor L, Beller EM, Hoffmann TC. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database Syst Rev. 2015;(11):CD010907....

2. Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev. 2013;(6):CD000247.

3. Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2014;(3):CD000245.

4. Centers for Disease Control and Prevention. Fast Facts. Get smart: know when antibiotics work. http://www.cdc.gov/getsmart/community/about/fast-facts.html. Accessed November 25, 2016.

5. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. http://www.cdc.gov/drugresistance/threat-report-2013/. Accessed November 25, 2016.

6. Sheridan SL, Harris RP, Woolf SH; Shared Decision-Making Workgroup of the U.S. Preventive Services Task Force. Shared decision making about screening and chemoprevention: a suggested approach from the U.S. Preventive Services Task Force. Am J Prev Med. 2004;26(1):56–66.

7. Snellman L, Adams W, Anderson G, et al. Diagnosis and treatment of respiratory illness in children and adults. Bloomington, Minn.: Institute for Clinical Systems Improvement; 2013.

8. Meeker D, Linder JA, Fox CR, et al. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: a randomized clinical trial. JAMA. 2016;315(6):562–570.

9. American Academy of Family Physicians. Fifteen things physicians and patients should question. Philadelphia, Pa.: Choosing Wisely; 2013.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.

 

 

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