Prescribing antibiotics may reinforce patients’ beliefs that antibiotics are needed and increase future consultations for similar symptoms. This review determines the effect of antibiotic prescribing for respiratory infections in primary care on future reattendance.
A systematic review and meta-analysis of randomised controlled trials (RCTs) and cohort studies and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Participants were adults or children presenting with respiratory infection in primary care.
MEDLINE (Ovid), PubMed, Embase, the Cochrane Central Register of Controlled Trials, clinical trial registries and grey literature sources were searched from inception until 6 February 2024.
Eligible studies included open-label RCTs or cohort studies of antibiotics compared with no antibiotics in adults or children with respiratory infections. The outcome of interest was reattendance at least 28 days after the initial consultation.
Two reviewers independently screened, selected, assessed the quality and extracted data. Separate meta-analyses were presented for RCT and cohort studies and a combined meta-analysis of all studies.
We identified 2128 records and reviewed 48 full texts, of which five met the inclusion criteria. These reported three RCTs (1207 randomised to antibiotics, 672 controls) and three cohort studies (209 138 exposed to antibiotics, 46 469 controls). In the meta-analysis of RCTs, relative risk (RR) of reattendance with antibiotics was 1.10 (95% CI: 0.99 to 1.23), and in cohort studies, RR was 1.21 (95% CI: 0.94 to 1.49). An important limitation is that most studies were in UK primary care.
Evidence suggests prescribing antibiotics for acute respiratory tract infections in primary care probably modestly increases future reattendance for similar conditions. Reducing antibiotic prescribing may help decrease demand for primary care.
CRD42023470731.
by Fahad Alzahrani, Nawaf Almutairi, Abdullah Aloufi, Abdulmalik Kattan, Abdulaziz Hakeem, Mohammed Alharbi, Naif Alarawi, Haifa A. Fadil, Ehsan Habeeb
ObjectivesEvidence-based medicine (EBM) combines clinical expertise, patient values, and the best available evidence to guide healthcare decision-making. Despite its importance in pharmacy practice, EBM adoption in Saudi Arabian pharmacies remains under-researched. This study aimed to assess the knowledge, attitudes, and practices regarding EBM among hospital and community pharmacists in the Madinah Region, Saudi Arabia.
MethodsA cross-sectional study was conducted with 206 pharmacists from September to November 2023. Data were collected through a validated online self-administered questionnaire to evaluate pharmacists’ knowledge, attitude, and practice (KAP), as well as their understanding of EBM technical terms.
Ethical approvalThe study was approved by the Scientific Ethics Committee of the College of Pharmacy at Taibah University, Madinah region, Saudi Arabia (reference number COPTU-REC-77–20230827). All participants received a consent form before participating.
ResultsPharmacists demonstrated moderate knowledge (76.5%), neutral attitudes (76%), and fair practices (68%) toward EBM, with hospital pharmacists scoring higher than community pharmacists. Moreover, 83.3% believed that EBM could enhance patient health outcomes, 80.0% were willing to learn, and 35.9% believed that EBM focuses solely on research without considering clinical experience. Time constraints (34.0%) were a major barrier, and 46.1% of the participants lacked appropriate training. EBM education was correlated with higher knowledge and attitude scores; however, it had no significant impact on practice scores. Significant barriers identified were the difficulty in conveying technical terms (16%) and limited access to adequate training opportunities.
ConclusionDespite positive attitudes toward EBM, many pharmacists perceive it as a potential threat to good clinical practice. This perception underscores the need for targeted educational initiatives that promote EBM benefits, address misconceptions, and provide practical support for its integration in both hospital and community pharmacy settings.