Antibiotic duration is often longer than necessary. Understanding the reasons for variability in antibiotic duration can inform interventions to reduce prolonged antibiotic use. Fernandez-Lazaro, et al. (2019) sought to describe patterns of inter-physician variability in prescribed antibiotic treatment durations and determine physician predictors of prolonged antibiotic duration in the community setting.
The researchers performed a retrospective cohort analysis of family physicians in Ontario, Canada, between March 1, 2016 and Feb. 28, 2017, using the Xponent TM dataset from IQVIA. The primary outcome was proportion of prolonged antibiotic course prescribed, defined as > 8 days of therapy. We used multivariable logistic regression models, with generalized estimating equations to account for physician level clustering to evaluate for predictors of prolonged antibiotic courses.
There were 10,616 family physicians included in the study, prescribing a total of 5.6 million antibiotic courses. There was substantial inter-physician variability in the proportion of prolonged antibiotic courses (median 33.3%, interquartile range 21.9–47.2%, interdecile range 13.5–60.3%). In the multivariable regression model, later physician career stage, rural location, and a larger pediatric practice were significantly associated with greater use of prolonged courses. Prolonged courses were more likely to be prescribed by late-career physicians (adjusted odds ratio 1.48, 95% confidence interval 1.38–1.58) and mid-career physicians (1.25, 1.16–1.34) when compared to early-career physicians.
The researchers observed substantial variability in prescribed antibiotic duration across family physicians, with durations particularly long among late-career physicians. They say these findings highlight opportunities for community antimicrobial stewardship interventions to improve antibiotic use through addressing practice differences in later career stage physicians.
Reference: Fernandez-Lazaro CI, et al. Late-Career Physicians Prescribe Longer Courses of Antibiotics. Clinical Infectious Diseases. Jan. 7, 2019. https://doi.org/10.1093/cid/ciy1130
Source: Clinical Infectious Diseases