International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
Factors associated with antibiotic prescription among patients with respiratory illness in Thailand: The potential impact of rapid influenza diagnostic testing in antimicrobial stewardship.
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Duanyai Chanakan, Kittikraisak Wanitchaya, Moolasart Visal, Piyaraj Phunlerd, Yoocharoen Pornsak, Nittayasoot Nattaprang, Tan Kathrine R, Davis William W, Chottanapund Suthat
Аннотация
OBJECTIVES: Overuse of antibiotics is one of the drivers of antimicrobial resistance, especially in acute respiratory tract infection. We examined factors associated with antibiotic prescription among patients treated at two Thai hospitals during 2018-2022.
METHODS: Medical records of patients with respiratory illness were reviewed to abstract demographics, clinical features, diagnostics, treatments, and outcomes. Factors associated with antibiotic prescribing were assessed. Inappropriate use was defined as antibiotic receipt without laboratory-confirmed bacterial infection, severe symptoms, or clinically suspected bacterial pneumonia.
RESULTS: Among 905 inpatients and 1811 outpatients, 46.7% and 31.9% received antibiotics, of which 7.8% and 45.1% were inappropriate, respectively. In-hospital antibiotic use was stable in 2018-2020 (59.0-64.0%) before declining sharply in 2022 (22.7%). Outpatient antibiotic use was stable in 2018-2019 (36.3-29.0%), increased in 2020-2021 (41.8-41.7%), and declined in 2022 (11.5%). Patients aged >65 years (adjusted relative risk [aRR] 1.30); males (aRR 1.11); and those with unstable vital signs (aRR 1.18), ancillary testing (aRR 1.37), hospitalization (aRR 1.23), or bacterial infection (aRR 1.71) had higher odds of receiving antibiotics. Children aged 1 year (aRR 0.81), those with a positive rapid influenza diagnostic test (aRR 0.32), and those treated at a study hospital (aRR 0.83) were less likely to receive antibiotics. Antiviral treatment was associated with lower antibiotic use in 2021-2022 (aRR 0.44 and 0.19) but not in 2019-2020.
CONCLUSION: Antibiotic use among patients with respiratory illness was common, although nearly half of outpatient prescriptions were inappropriate. A positive result from rapid influenza diagnostic test was associated with reduced antibiotic prescribing.
METHODS: Medical records of patients with respiratory illness were reviewed to abstract demographics, clinical features, diagnostics, treatments, and outcomes. Factors associated with antibiotic prescribing were assessed. Inappropriate use was defined as antibiotic receipt without laboratory-confirmed bacterial infection, severe symptoms, or clinically suspected bacterial pneumonia.
RESULTS: Among 905 inpatients and 1811 outpatients, 46.7% and 31.9% received antibiotics, of which 7.8% and 45.1% were inappropriate, respectively. In-hospital antibiotic use was stable in 2018-2020 (59.0-64.0%) before declining sharply in 2022 (22.7%). Outpatient antibiotic use was stable in 2018-2019 (36.3-29.0%), increased in 2020-2021 (41.8-41.7%), and declined in 2022 (11.5%). Patients aged >65 years (adjusted relative risk [aRR] 1.30); males (aRR 1.11); and those with unstable vital signs (aRR 1.18), ancillary testing (aRR 1.37), hospitalization (aRR 1.23), or bacterial infection (aRR 1.71) had higher odds of receiving antibiotics. Children aged 1 year (aRR 0.81), those with a positive rapid influenza diagnostic test (aRR 0.32), and those treated at a study hospital (aRR 0.83) were less likely to receive antibiotics. Antiviral treatment was associated with lower antibiotic use in 2021-2022 (aRR 0.44 and 0.19) but not in 2019-2020.
CONCLUSION: Antibiotic use among patients with respiratory illness was common, although nearly half of outpatient prescriptions were inappropriate. A positive result from rapid influenza diagnostic test was associated with reduced antibiotic prescribing.