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

Roshini Claire Anthony
11 Jan 2017

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.

 

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Most Read Articles
31 Oct 2017
In patients with underlying heart failure (HF) or chronic obstructive pulmonary disease (COPD), concurrent episodes of community-acquired pneumonia increase the risk of disease exacerbations, such as short-term cardiac complications and respiratory failure, a recent study has shown.
16 Mar 2017
Probiotics have a long history of use in humans. Defined as "live organisms that confer a health benefit on the host when administered in adequate amounts", the spectrum of use of probiotics in humans ranges from foods and dietary supplements to pharmaceutical/nutraceutical products to affect general health and disease. While the genera Lactobacillus and Bifidobacterium are the two most common probiotics associated with consumer products, there exist other organisms (eg, the yeast Saccharomyces cerevisiae, some non-pathogenic strains of Escherichia coli and Bacillus species) that are used as probiotics.1–3 One of them is the probiotic strain B. clausii that has been found to be effective for the treatment of diarrhoea and antibiotic-associated gastrointestinal side effects.4–6
02 Nov 2017
Passive immunization with neutralizing antibodies (nAbs) do not appear to prevent transmission of HIV-1 to the infant from the infected mother’s breastmilk, a recent study suggests.
Stephen Padilla, 06 Dec 2016
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