Evidence map›Paper›PMID 32727604›Full record

ArticleBMC medicine2020

Why do hospital prescribers continue antibiotics when it is safe to stop? Results of a choice experiment survey.

Laurence S J Roope, James Buchanan, Liz Morrell, Koen B Pouwels, Katy Sivyer, Fiona Mowbray, Lucy Abel, Elizabeth L A Cross, Lucy Yardley, Tim Peto and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

  1. Article
  2. When to Stop Antibiotics in the Critically Ill?Antibiotics (Basel, Switzerland) · 2024
    Review
  3. Article
  4. Article
  5. Article
  6. Article
  7. Article
  8. Article
  9. Overuse of antibiotics: Can viral vaccinations help stem the tide?British journal of clinical pharmacology · 2021
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Laurence S J RoopeHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK. laurence.roope@dph.ox.ac.uk.ORCID 0000-0001-9098-9331
James BuchananHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
Liz MorrellHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
Koen B PouwelsHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
Katy SivyerCentre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
Fiona MowbrayCentre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
Lucy AbelNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Elizabeth L A CrossDepartment of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, UK.
Lucy YardleyCentre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
Tim PetoNIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK.
A Sarah WalkerNIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK.
Martin J LlewelynDepartment of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, UK.
Sarah WordsworthHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.

Funding

National Institute for Health Research RP-PG-0514-20015
6 · The paper itself

Abstract

backgroundDeciding whether to discontinue antibiotics at early review is a cornerstone of hospital antimicrobial stewardship practice worldwide. In England, this approach is described in government guidance ('Start Smart then Focus'). However, < 10% of hospital antibiotic prescriptions are discontinued at review, despite evidence that 20-30% could be discontinued safely. We aimed to quantify the relative importance of factors influencing prescriber decision-making at review.

methodsWe conducted an online choice experiment, a survey method to elicit preferences. Acute/general hospital prescribers in England were asked if they would continue or discontinue antibiotic treatment in 15 hypothetical scenarios. Scenarios were described according to six attributes, including patients' presenting symptoms and whether discontinuation would conflict with local prescribing guidelines. Respondents' choices were analysed using conditional logistic regression.

resultsOne hundred respondents completed the survey. Respondents were more likely to continue antibiotics when discontinuation would 'strongly conflict' with local guidelines (average marginal effect (AME) on the probability of continuing + 0.194 (p < 0.001)), when presenting symptoms more clearly indicated antibiotics (AME of urinary tract infection symptoms + 0.173 (p < 0.001) versus unclear symptoms) and when patients had severe frailty/comorbidities (AME = + 0.101 (p < 0.001)). Respondents were less likely to continue antibiotics when under no external pressure to continue (AME = - 0.101 (p < 0.001)). Decisions were also influenced by the risks to patient health of continuing/discontinuing antibiotic treatment.

conclusionsGuidelines that conflict with antibiotic discontinuation (e.g. pre-specify fixed durations) may discourage safe discontinuation at review. In contrast, guidelines conditional on patient factors/treatment response could help hospital prescribers discontinue antibiotics if diagnostic information suggesting they are no longer needed is available.

Indexed as

AdultAgedAnti-Bacterial AgentsFemaleHospitalsHumansMaleMiddle AgedSurveys and QuestionnairesAnti-Bacterial AgentsAntibiotic prescribingAntibiotic stewardshipHospitals

Identifiers

PMID32727604
PMCPMC7391515

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.