Antibiotic expectation, behaviour, and receipt among patients presenting to emergency departments with uncomplicated upper respiratory tract infection during the COVID-19 pandemic

• Published in: Journal of Global Antimicrobial Resistance Vol. 33; pp. 89 - 96
• Main Authors: Huang, Zhilian, Kuan, Win Sen, Tan, Hann Yee, Seow, Eillyne, Tiah, Ling, Peng, Li Lee, Weng, Yanyi, Chow, Angela
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2023; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics expectation; Antimicrobial resistance; Antimicrobial Stewardship; COVID-19; COVID-19 - epidemiology; COVID-19 - psychology; Cross-Sectional Studies; Drug Prescriptions; Drug Resistance, Bacterial; Emergency department; Emergency Room Visits; Emergency Service, Hospital; Female; Health Behavior; Humans; Infectious Disease; Male; Middle Aged; Motivation; Pandemics; Patient Education as Topic; Patients - psychology; Respiratory Tract Infections - drug therapy; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - psychology; Singapore; Young Adult; Singapore; COVID-19; Emergency department; Antimicrobial resistance; Antibiotics expectation
• ISSN: 2213-7165; 2213-7173; 2213-7173
• DOI: 10.1016/j.jgar.2023.02.025

Pre-COVID-19 pandemic, patients who attended the emergency department (ED) for upper respiratory tract infection (URTI) were more likely to receive antibiotics if they expected them. These expectations could have changed with the change in health-seeking behaviour during the pandemic. We assessed the factors associated with antibiotics expectation and receipt for uncomplicated URTI patients in four Singapore EDs during the COVID-19 pandemic. We conducted a cross-sectional study on adult patients with URTI from March 2021 to March 2022 in four Singapore EDs and assessed the determinants of antibiotics expectation and receipt using multivariable logistic regression models. We also assessed the reasons patients expect antibiotics during their ED visit. Among 681 patients, 31.0% expected antibiotics while 8.7% received antibiotics during their ED visit. Factors (adjusted odds ratio [95% confidence interval]) that significantly influenced expectation for antibiotics include: 1) prior consultation for current illness with (6.56 [3.30–13.11]) or without (1.50 [1.01–2.23]) antibiotics prescribed; 2) anticipation for COVID-19 test (1.56 [1.01–2.41]); and 3) poor (2.16 [1.26–3.68]) to moderate (2.26 [1.33–3.84]) knowledge on antibiotics use and resistance. Patients expecting antibiotics were 10.6 times (10.64 [5.34–21.17]) more likely to receive antibiotics. Those with tertiary education were twice (2.20 [1.09–4.43]) as likely to receive antibiotics. In conclusion, patients with URTI who expected antibiotics to be prescribed remained more likely to receive it during the COVID-19 pandemic. This highlights the need for more public education on the non-necessity for antibiotics for URTI and COVID-19 to address the problem of antibiotic resistance.