Factors affecting nonadherence with antibiotics

doi:10.1016/0732-8893(92)90136-H

Diagnostic Microbiology and Infectious Disease

Volume 15, Issue 4, Supplement, May–June 1992, Pages 103-109

https://doi.org/10.1016/0732-8893(92)90136-H Get rights and content

Abstract

Nonadherence with antibiotic therapy has profound implications both for patient health and the health care system that bears the financial costs incurred. Significant levels of nonadherence with antibiotic prescriptions have been demonstrated. Of the many proposed variables involved, those that are potentially modifiable relate to aspects of the doctor-patient interaction and drug regimen. Despite the potential for intervention with these variables, there have been very few methodologically sound studies examining their effect on adherence with either medications generally or antibiotics specifically. Only two studies were located that had tested the effectiveness of reduced complexity of antibiotic dosage schedules. The results suggest that the less complex the schedule, the greater is the adherence. Both practitioners and patients must be encouraged to use and accept simpler dosage schedules, preferably once-daily schedules wherever possible. The paucity of well-controlled studoes to date highlights the need for further research evaluating intervention strategies that utilize variations in dosage schedule and elements of the doctor-patient interaction to improve adherence with antibiotic medications.

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Monotherapy is preferred to treatment with two or more agents. Antibiotics that can be administered once daily rather than two or more times daily may also improve adherence to therapy [32]. Tolerability is also an important consideration when selecting an antibiotic for pediatric use.
To review and summarize recent challenges in the microbiology and treatment of acute bacterial sinusitis (ABS), one of the most common infectious diseases in the pediatric community.
A review of recent medical literature from 1990 to 2006 was acquired using the National Library of Medicine's PUBMED database.
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Treatment of ABS in children is complicated by a number of emerging changes in pathogen resistance patterns. These include β-lactamase-negative ampicillin resistance (BLNAR) and multi-drug resistance, bacterial interference, and geographic data. These phenomena are likely to impact the treatment of URIs. Appropriate diagnosis and differentiation from viral sinusitis is essential prior to initiating therapy. Clinician education about these emerging issues remains an important strategy in diagnosing and treating ABS in children. This includes an understanding of known patient adherence to antibiotic therapy, such as taste, tolerability, dosing schedule, therapy duration, and patient preference. Clinicians should review judicious ABS treatment approaches that employ agents with documented efficacy against implicated pathogens.
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Respiratory tract infections account for more than 116 million office visits and an estimated 3 million visits to hospital EDs annually. Patients presenting at EDs with symptoms suggestive of lower respiratory tract infections of suspected bacterial etiology are often severely ill, thus requiring a rapid presumptive diagnosis and empiric antimicrobial treatment. Traditionally, clinicians have relied on β-lactam or macrolide antibiotics to manage community-acquired lower respiratory tract infections. However, the emerging resistance of Streptococcus pneumoniae to β-lactams and/or macrolides may affect the clinical efficacy of these agents. Inappropriate use of antibiotics and use of agents with an overly broad spectrum of antimicrobial activity have contributed to the emergence of antibiotic resistance. When treating respiratory infections, clinicians need to prescribe antimicrobial agents only for those individuals with infections of suspected bacterial etiology; to select agents with a targeted spectrum of activity that ensures coverage against typical S pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis strains, including antibiotic-resistant strains and atypical pathogens; and to consider agents with specific chemical properties that limit the development of antimicrobial resistance and that achieve concentrations at sites of infection that exceed those required for bactericidal activity. Newer classes of antimicrobial agents, such as the oxazolidinones and ketolides, will likely play a significant role in this era of antimicrobial resistance.
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Several factors were identified that should be considered when choosing empiric antibiotic therapy for community-acquired RTIs with the goal of improving clinical outcomes while minimizing the risk of resistance. These factors include spectrum of activity, bactericidal vs bacteriostatic activity, chemical structure, elimination half-life, and potency.
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Factors affecting nonadherence with antibiotics☆

Abstract

J Am Pharm Assoc

Sociobehavioral determinants of compliance with health and medical care recommendations

Med Care

Strategies for enhancing patient compliance

J Commun Health

Patient perception and compliance: recent studies of the health belief model

Failure of children to receive penicillin by mouth

N Engl J Med

The paradox of using a 7 day antibacterial course to treat urinary tract infections in the community

Br J Clin Pharmacol

Variables related to antibiotic compliance in general practice patients: the application of behavioural science methodologies

Determinants of non-compliance with short-term antibiotic regimens

Br Med J Clin Res

Effects of intervention on antibiotic compliance in patients in general practice

Med J Aust

The process and content of general practice consultations that involve prescription of antibiotic agents

Med J Aust

Compliance aiding strategies: a guide for the busy practitioner

Aust Prescriber

Estimatung worldwide current antibiotic usage: report of Task Force 1

Rev Infect Dis

How often is medication taken as prescribed? A novel assessment technique

J Am Med Assoc

Construct validity comparisons of three methods for measuring patient compliance

Health Serv Res

Variations in patients' compliance with doctors' advice: an empirical analysis of patterns of communication

Am J Publ Health

Following advice in general practice

J R Coll Gen Pract

Issues in assessment

The effect of prescribed daily dose frequency on patient medication compliance

Arch Intern Med

Understanding and improving patient compliance

Ann Intern Med

General practice compliance study: is it worth being a personal doctor?

Br Med J

To be taken as directed

J R Coll Gen Pract

Predicting compliance with a regimen of digoxin therapy in family practice

Can Med Assoc J

Diagnosis and management of patient non-compliance

J Am Med Assoc