Low BMI, symptom persistence tied to increased antibiotic use in Singaporean adults

20170111131000, Roshini Claire Anthony

Low body mass index (BMI) and persistence of symptoms appear to influence antibiotic use among Singaporeans, a recent study demonstrated.

After adjusting for age, gender, primary care clinic, and enrolment year, a lower BMI (<18.5 kg/m2) was associated with a higher likelihood for antibiotic use (odds ratio [OR], 1.87, 95 percent confidence interval [CI], 1.19–2.93; p=0.01). [Antimicrob Resist Infect Control 2016;5:47]

The persistence of symptoms at 2–3 days follow-up was also associated with a higher likelihood of antibiotic use (OR, 2.00, 95 percent CI, 1.38–2.92 for one symptom, OR, 2.67, 95 percent CI, 1.80–3.97 for two symptoms, OR, 4.26, 95 percent CI, 2.73–6.64 for three symptoms, and OR, 2.79, 95 percent CI, 1.84–4.24 for four or more persisting symptoms; p<0.0001 for all). An elevated white blood cell count was also tied to antibiotic use (OR, 1.98, 95 percent CI, 1.42–2.78; p<0.0001).

According to the authors, clinicians may perceive a low BMI and persisting symptoms as risk factors for more serious or secondary illness, while a high white blood cell count may signal a bacterial infection, thus increasing the likelihood of prescribing antibiotics.

A higher socioeconomic status was also associated with antibiotic use, with individuals living in landed properties more likely to use antibiotics compared with those living in public housing (OR, 1.73, 95 percent CI, 1.06–2.80; p=0.0045).

“A possible explanation to our finding is that patients of higher socioeconomic status were more likely to expect an antibiotic prescription from physicians,” said the authors.

In the Early DENgue infection and outcome (EDEN) study, researchers recruited 1,884 adults (mean age 36.7 years, 66 percent male) who presented at five primary care clinics in Singapore with acute febrile illness (body temperature ≥38oC for less than 72 hours) between December 2007 and February 2013, 16 percent of whom (n=309) reported antibiotic usage. Use of analgesics, cough medicines, and cold remedies was reported by 16, 32, and 20 percent of participants, respectively. Participants were followed up at 2–3 days and 4 weeks after the first primary care consultation.

According to the authors, information on the use of antibiotics in primary care in Singapore has been lacking, with more attention given to patterns of use in the hospital setting. They recommended that further studies evaluating antibiotic prescription in the private sector be conducted to provide a more holistic look at antibiotic use in primary care.

“Further work to understand trends of antibiotic use ... as well as factors that influence patient expectation and physician prescribing of antibiotics is important, in order to identify opportunities to rationalize antibiotic use and develop policies for optimal antibiotic use in primary care,” they said.