Cambridge University Press
Supplementary. Multifaceted intervention for improving discharge antimicrobial prescription in the emergency departmentAuthors: Yasuaki Tagashira MD, PhD, Manaka Goto MD, Reiko Kondo MD, Hitoshi Honda MD, PhDSupplementary Table 1. A list of indications and appropriate antimicrobial prescriptions for infectious diseases encountered in the emergency department DiagnosisSummary of antibiotic treatment indicationsDrug, dosageReferencesSinusitisPrescribe antimicrobial agents to adults with acute bacterial sinusitis (diagnosed strictly per criteria) with 1) Onset with persistent symptoms or signs compatible with acute rhinosinusitis lasting >10 days without any evidence of clinical improvement, 2) Onset with severe symptoms or signs of high fever (>39°C [102°F]) and purulent nasal discharge or facial pain lasting at least 3–4 consecutive days at the beginning of illness, 3) Onset with worsening symptoms or signs characterized by a new onset of fever, headache or increase in nasal discharge following a typical viral upper respiratory tract infection (URI) lasting 5–6 days despite initial improvement of symptomsAmoxicillin-clavulanate 500/125 mg orally three times daily or 875/125 mg orally twice dailyAmoxicillin 500 mg orally three times dailyDoxycycline 100 mg orally twice dailyFor patients with a history of penicillin allergy:Doxycycline 100 mg orally twice dailyLevofloxacin 500 mg orally once dailyMoxifloxacin 400 mg orally once dailyChow et al.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DaG93PC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA 1PharyngitisPrescribe antimicrobial agents only to patients with proven acute group A streptococcal pharyngitis or patients with high likelihood of streptococcal infection (e.g. 4 Centor criteria)Penicillin V 250 mg orally four times daily or 500 mg orally twice daily (N/A in Japan)Amoxicillin 1000 mg orally once daily or 500 mg orally twice dailyFor patients with a history of penicillin allergy:Cephalexin 500 mg orally twice dailyClindamycin 300 mg orally three times dailyAzithromycin 500 mg orally once daily Clarithromycin 250 mg orally twice dailyChoby et al. ADDIN EN.CITE <EndNote><Cite><Author>Choby</Author><Year>2009</Year><RecNum>4665</RecNum><DisplayText><style face="superscript">2</style></DisplayText><record><rec-number>4665</rec-number><foreign-keys><key app="EN" db-id="tsr25ttv2a95wkedadt5fvvkwpdswrzs225a" timestamp="1499672919">4665</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Choby, B. A.</author></authors></contributors><auth-address>Department of Family Medicine, University of Tennessee College of Medicine-Chattanooga, UT Family Practice Center, 37403, USA. beth.choby@</auth-address><titles><title>Diagnosis and treatment of streptococcal pharyngitis</title><secondary-title>Am Fam Physician</secondary-title></titles><periodical><full-title>Am Fam Physician</full-title></periodical><pages>383-90</pages><volume>79</volume><number>5</number><edition>2009/03/12</edition><keywords><keyword>Algorithms</keyword><keyword>Anti-Bacterial Agents/*therapeutic use</keyword><keyword>Humans</keyword><keyword>Nephritis/etiology</keyword><keyword>Pharyngitis/drug therapy/*microbiology</keyword><keyword>Practice Guidelines as Topic</keyword><keyword>Rheumatic Fever/etiology</keyword><keyword>Streptococcal Infections/complications/*diagnosis/*drug therapy</keyword><keyword>Streptococcus pyogenes/*isolation & purification</keyword></keywords><dates><year>2009</year><pub-dates><date>Mar 01</date></pub-dates></dates><isbn>0002-838X (Print)
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ADDIN EN.CITE.DATA 3Suppurative otitis mediaAntimicrobial therapy is not recommended immediately except in cases of immunocompromised patients, patients with persistent symptoms or those with suppurative otitis media.Amoxicillin 500 mg orally three times dailyAmoxicillin-clavulanate 500/125 mg orally three times daily or 875/125 mg orally twice dailyFor patients with a history of penicillin allergy:Cefdinir 300 mg orally twice dailyCefpodoxime 200 mg orally twice dailyCeftriaxone 1 g once dailyCefuroxime 500 mg orally twice dailyNeff, M. J. et al. ADDIN EN.CITE <EndNote><Cite><Author>Neff</Author><Year>2004</Year><RecNum>217</RecNum><DisplayText><style face="superscript">4</style></DisplayText><record><rec-number>217</rec-number><foreign-keys><key app="EN" db-id="tddrw5vafep5d0eafavxxv9fa5exrprssvvd" timestamp="1563519900">217</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Neff, M. J.</author><author>American Academy of, Pediatrics</author><author>American Academy of Family, Physicians</author></authors></contributors><titles><title>AAP, AAFP release guideline on diagnosis and management of acute otitis media</title><secondary-title>Am Fam Physician</secondary-title></titles><periodical><full-title>Am Fam Physician</full-title></periodical><pages>2713-5</pages><volume>69</volume><number>11</number><edition>2004/06/19</edition><keywords><keyword>Acute Disease</keyword><keyword>Anti-Bacterial Agents/therapeutic use</keyword><keyword>Child</keyword><keyword>Humans</keyword><keyword>Otitis Media/*diagnosis/drug therapy/*therapy</keyword></keywords><dates><year>2004</year><pub-dates><date>Jun 01</date></pub-dates></dates><isbn>0002-838X (Print)
0002-838X (Linking)</isbn><accession-num>15202704</accession-num><urls><related-urls><url> guideline [NG91] ADDIN EN.CITE <EndNote><Cite><Year>2018</Year><RecNum>4987</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>4987</rec-number><foreign-keys><key app="EN" db-id="tsr25ttv2a95wkedadt5fvvkwpdswrzs225a" timestamp="1530875341">4987</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>National Institute for Health and Care Execellence Otitis media (acute): antimicrobial prescribing (NICE Guideline 91)</title></titles><dates><year>2018</year></dates><urls><related-urls><url> therapy is recommended.1) Previously healthy patients with no antimicrobial use within the previous 3 months:Azithromycin 500 mg orally once daily or one 2 g dose orally Clarithromycin 500 mg orally twice daily Doxycycline 100 mg orally twice daily2) Presence of comorbidities, such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressive conditions or use of immunosuppressive drugs; use of antimicrobials within the previous 3 months (in which case an alternative from a different class should be selected):Levofloxacin 750 mg orally once daily or moxifloxacin 400 mg orally once dailyAmoxicillin-clavulanate 500/125 mg orally three times daily or 875/125 mg orally twice daily or ceftriaxone 1-2 g once daily and either azithromycin 500 mg orally once daily or one dose of azithromycin 2 g orally or clarithromycin 500 mg orally twice dailyMandell et al. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYW5kZWxsPC9BdXRob3I+PFllYXI+MjAwNzwvWWVhcj48
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ADDIN EN.CITE.DATA 8Acute gastroenteritis(treatment for travelers’ diarrhea) **Antimicrobial therapy is not recommended, except in cases of Travelers’ diarrhea where the likelihood of bacterial pathogens is high enough to justify the potential side effects of antibiotics.Levofloxacin 500 mg orally once daily Ciprofloxacin 750 mg orally once daily Ofloxacin 400 mg orally once dailyAzithromycin 1 g orally once or 500 mg orally once dailyRiddle et al. ADDIN EN.CITE <EndNote><Cite><Author>Riddle</Author><Year>2016</Year><RecNum>223</RecNum><DisplayText><style face="superscript">9</style></DisplayText><record><rec-number>223</rec-number><foreign-keys><key app="EN" db-id="tddrw5vafep5d0eafavxxv9fa5exrprssvvd" timestamp="1563519956">223</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Riddle, M. S.</author><author>DuPont, H. L.</author><author>Connor, B. A.</author></authors></contributors><auth-address>Enteric Diseases Department, Naval Medical Research Center, Silver Spring, Maryland, USA.
University of Texas Health Science Center at Houston, Houston, Texas, USA.
Weill Medical College of Cornell University, New York, New York, USA.</auth-address><titles><title>ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults</title><secondary-title>Am J Gastroenterol</secondary-title></titles><periodical><full-title>Am J Gastroenterol</full-title></periodical><pages>602-22</pages><volume>111</volume><number>5</number><edition>2016/04/14</edition><keywords><keyword>Acute Disease</keyword><keyword>Adult</keyword><keyword>Algorithms</keyword><keyword>Diarrhea/*diagnosis/etiology/*therapy</keyword><keyword>Humans</keyword><keyword>United States</keyword></keywords><dates><year>2016</year><pub-dates><date>May</date></pub-dates></dates><isbn>1572-0241 (Electronic)
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ADDIN EN.CITE.DATA 10Cutaneous and mucosal infectionsAntimicrobial therapy is recommended.Impetigo:Cephalexin 250 mg orally four times dailyErythromycin 250 mg orally four times dailyClindamycin 300-400 mg orally four times dailyAmoxicillin-clavulanate 500/125 mg orally three times daily or 875/125 mg orally twice dailySSTI: patients with no SIRS, altered mental status or hemodynamic instabilityClindamycin 300-450 mg orally four times dailyCephalexin 500 mg orally four times dailyDoxycycline/Minocycline 100 mg orally twice dailyTrimethoprim-sulfamethoxazole 160/800-320/1600 mg orally twice dailyStevens et al.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdGV2ZW5zPC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48
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ADDIN EN.CITE.DATA 11Traumatic injury1) Open fractures; antimicrobial therapy is recommended.2) Some bite wounds; routine antimicrobial therapy is not recommended for every uninfected animal bite injury. The following conditions should be considered: patients who (a) are immunocompromised; (b) have advanced liver disease; (c) have pre-existing or resultant edema in the affected area; (d) have moderate to severe injuries, especially to the hand or face; or (e) have injuries that may have penetrated the periosteum or joint capsule.Bites wounds; Amoxicillin-clavulanate 500/125 mg orally three times daily or 875/125?mg orally twice dailyThe following regimens can be considered for adults with penicillin allergy: Clindamycin 300?mg orally four times daily and either ciprofloxacin 500?mg orally twice daily or levofloxacin 500?mg orally daily or trimethoprim-sulfamethoxazole 160/800 mg orally twice dailyOpen fracture:For type 1 fractures, systemic antibiotic coverage directed at gram-positive organisms For type 3 fractures, additional gram-negative coverage should be added.Stevens et al.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdGV2ZW5zPC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48
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ADDIN EN.CITE.DATA 11Hoff et al. ADDIN EN.CITE <EndNote><Cite><Author>Hoff</Author><Year>2011</Year><RecNum>225</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>225</rec-number><foreign-keys><key app="EN" db-id="tddrw5vafep5d0eafavxxv9fa5exrprssvvd" timestamp="1563519956">225</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hoff, W. S.</author><author>Bonadies, J. A.</author><author>Cachecho, R.</author><author>Dorlac, W. C.</author></authors></contributors><auth-address>Division of Trauma, St. Luke's Hospital, Bethlehem, Pennsylvania, USA.</auth-address><titles><title>East Practice Management Guidelines Work Group: update to practice management guidelines for prophylactic antibiotic use in open fractures</title><secondary-title>J Trauma</secondary-title></titles><periodical><full-title>J Trauma</full-title></periodical><pages>751-4</pages><volume>70</volume><number>3</number><edition>2011/05/26</edition><keywords><keyword>*Antibiotic Prophylaxis</keyword><keyword>Fractures, Open/classification/*drug therapy</keyword><keyword>Humans</keyword><keyword>Wound Infection/*prevention & control</keyword></keywords><dates><year>2011</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1529-8809 (Electronic)
0022-5282 (Linking)</isbn><accession-num>21610369</accession-num><urls><related-urls><url> therapy is recommended.Diseases characterized by urethritis (esp. N. gonorrhoeae and C. trachomatis): Ceftriaxone 1 g, 1 dose and azithromycin 1 g, 1 dose orally Azithromycin 1 g, 1 dose orally or doxycycline 100 mg orally twice dailyPelvic inflammatory diseases:Ceftriaxone 1 g, 1 dose and doxycycline 100 mg orally twice daily with or without metronidazole 500 mg orally twice dailyWorkowski et al. ADDIN EN.CITE <EndNote><Cite><Year>2015</Year><RecNum>222</RecNum><DisplayText><style face="superscript">13</style></DisplayText><record><rec-number>222</rec-number><foreign-keys><key app="EN" db-id="tddrw5vafep5d0eafavxxv9fa5exrprssvvd" timestamp="1563519900">222</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines</title><secondary-title>J Miss State Med Assoc</secondary-title></titles><periodical><full-title>J Miss State Med Assoc</full-title></periodical><pages>372-5</pages><volume>56</volume><number>12</number><edition>2016/03/16</edition><keywords><keyword>Centers for Disease Control and Prevention (U.S.)</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Sexually Transmitted Diseases/*drug therapy</keyword><keyword>United States</keyword></keywords><dates><year>2015</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>0026-6396 (Print)
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ADDIN EN.CITE.DATA 14Abbreviations:COPD, chronic obstructive pulmonary disease; UTI, urinary tract infection; SSTI, skin and soft tissue infection; STD, sexually transmitted disease* Quinolones are not indicated for treatment of UTI due to quinolone resistance in E. coli exceeding > 10% at the study institution.** If symptoms are not resolved after 24 h, complete a 3-day course of antimicrobial therapySupplementary Table 2. The definition of antimicrobial appropriatenessTermDefinitionAppropriateNot meeting the following classification of misuseMisuseAntimicrobial prescription at discharge which failed to meet the criteria outlined in the pocket guide UnnecessaryThe use for non-infectious conditions, nonbacterial infections or self-limiting bacterial infections and included antimicrobial use in cases of uncertain diagnosis InappropriateThe use of an antimicrobial agent not conforming to current treatment protocols or against a pathogen resistant to the agent SuboptimalThe use of an antimicrobial that could have been?improved in one of the following categories: drug delivery route, dosage interval or dosage.Note. We referred to the previously mentioned criteria.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GbGVtaW5nLUR1dHJhPC9BdXRob3I+PFllYXI+MjAxNjwv
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ADDIN EN.CITE.DATA 15-17Supplementary Table 3. Baseline characteristics of patients with APD in the emergency department (N=2,835)CharacteristicsPre-intervention period(N=1,555)Interventionperiod(N=1,280)PvalueDemographicsAge, year, median (range) 45 (13-98) 51 (14-95)<0.001 ≤ 40 653 (42.0) 454 (35.5) Ref. 40-65 491 (31.6) 387 (30.2)0.17 ≥ 65 411 (26.4) 439 (34.3)<0.001Female gender 852 (54.9)731 (57.1)0.22Residential status prior to ED visit Home 1550 (99.7)1,262 (98.6)Ref. Nursing home 5 (0.3)18 (1.4)0.001Post-travel visit 5 (0.3)0 (0)N/AAntimicrobial allergy 28 (1.8)70 (5.8)<0.001Comorbidity/past medical history Congestive heart failure 23 (1.5)30 (2.3)0.09 History of myocardial infarction 42 (2.7)25 (2.0)0.19 History of asthma 129 (8.3)109 (8.5)0.83 Chronic lung disease 20 (1.3)49 (3.8)<0.001 Active solid organ malignancy 106 (6.8)53 (4.1)0.002 Diabetes mellitus 115 (7.4)100 (7.8)0.68 Hypertension 234 (15.0)245 (19.1)0.004 Peptic ulcer disease 39 (2.5)8 (0.6)<0.001 Cerebrovascular disease 56 (3.6)50 (3.9)0.67 Chronic liver disease 18 (1.2)34 (2.7)0.003 Chronic kidney disease 14 (0.9)8 (0.6)0.41 Connective tissue disease 47 (3.0)49 (3.8)0.24 Dementia 28 (1.8)19 (1.5)0.51 Psychiatric illness 67 (4.3)67 (5.2)0.25 Systemic steroid use (≥ 5 mg) in the last 28 days 37 (2.4)26 (2.0)0.53 Chemotherapy in the last 28 days 33 (2.1)29 (2.3)0.80 HIV 3 (0.2)1 (0.1)0.42Time of visit to the ED Daytime (8:00-16:59) 795 (51.1)624 (48.8)Ref. Night (17:00-23:59) 540 (34.8)437 (34.1)0.72 Late-night (0:00-7:59) 220 (14.1)219 (17.1)0.03Day of ED visit Weekday (Monday through Friday) 808 (52.0)651 (50.9)Ref. Weekend (Saturday and Sunday) or holiday 747 (48.0) 629 (49.1)0.56Seasonality April-September (spring and summer) 811 (52.1)544 (42.5)Ref. October-March (autumn and winter) 744 (47.9)736 (57.5)0.004NOTE. Data are presented as a number (%) unless otherwise specified.Abbreviations: ED, emergency department; COPD, chronic obstructive pulmonary diseaseSupplementary Table 4. Characteristics of physicians prescribing discharge antimicrobials in the emergency department (N=2,835)CharacteristicsPre-intervention period(N=1,555)Intervention period(N=1,280)Department Emergency Department927 (59.6)832 (65.0) Department of Medicine a167 (10.7)128 (10.0) Department of Surgery b421 (27.1)320 (25.0)Occupational status of prescribing physicians Resident958 (61.6)832 (65.0) Physician in a medical subspecialty c269 (17.3)128 (10.0) Physician in a surgical subspecialty c328 (21.1)320 (25.0)Prescribing physician’s post graduate year ≤ 3418 (26.9)459 (35.9) 4-7774 (47.8)561 (43.8) ≥ 8363 (23.3)260 (20.3)Sex Male991 (63.7)840 (65.6) Female564 (36.3)440 (34.4)NOTE. Data are presented as a number (%) unless otherwise specified.a Medical department includes the department of general medicine and the pulmonary, gastroenterology, nephrology, and infectious diseases departments.b Surgical department includes the departments of general surgery, otorhinolaryngology, urology, obstetrics/gynecology, oral surgery, orthopedics, plastic surgery, neurosurgery, and dermatology.c Physicians in subspecialties include subspecialty fellows and attending physicians.Supplementary Table 5. Interrupted time-series analysis of changes in APD trendsRegression interceptPre-intervention trend Changeafter the start of interventionPChange intrend during intervention periodPNumber of antimicrobial prescriptions43.70 (37.73 to 49.73)-0.19(-0.98 to 0.59)-8.57(-15.92 to 1.22)0.03+1.08(0.10 to 2.07)0.03Proportion of appropriate prescriptions40.70(33.26 to 48.23)+1.18(0.23 to 2.11)+18.07(9.68 to 26.50)<0.01+0.24(-1.19 to 1.24)0.97Proportion of overall misuse prescriptions59.26(51.77 to 66.74)-1.18(-2.12 to -0.23)-18.01(-26.43 to -9.69)<0.01-0.03(-1.24 to 1.19)0.97Unnecessary prescriptions31.19(25.44 to 36.94)-0.38(-1.22 to 0.46)-16.41(-23.90 to -8.92)<0.001+0.13(-0.96 to 1.22)0.81 Inappropriate prescriptions24.84(22.58 to 27.10)-0.76(-1.19 to 0.34)-3.08(-6.87 to 0.70)0.10+0.03(0.58 to 0.64)0.92 Suboptimal prescriptions3.23(1.64 to 4.82)-0.03(-0.25 to 0.19)+1.49(-1.26 to 4.23)0.27-0.19(-0.54 to 0.16)0.28Data are presented as mean monthly prescriptions per 1,000 visits with 95% confidence intervals unless otherwise specified. Supplementary Table 6. Details of prescribing patterns in 250 physicians in the emergency departmentNumber of physicians(N =250)Number of discharge antimicrobial prescriptions per physician, median (range) 4 (1-32)Number of physicians with at least one episode of misuse of discharge antimicrobial prescription139 (55.6)Number of physicians prescribing antimicrobials appropriately on the next prescribing occasion 97/139 (69.8)Number of physicians with more than two episodes of misuse of discharge antimicrobial prescription 59 (23.6)Number of physicians with at least one episode of unnecessary discharge antimicrobial prescription 72 (28.8)Number of physicians prescribing antimicrobials appropriately on the next prescribing occasion36/72 (50.0)Number of physicians with more than two episodes of unnecessary discharge antimicrobial prescription 22 (8.8)Number of physicians with at least one episode of inappropriate discharge antimicrobial prescription 84 (33.6)Number of physicians prescribing antimicrobials appropriately on the next prescribing occasion47/84 (56.0)Number of physicians with more than two episodes of inappropriate discharge antimicrobial prescription 24 (16.0)Number of physicians with at least one episode of suboptimal discharge antimicrobial prescription 28 (11.2)Number of physicians prescribing antimicrobials appropriately on the next prescribing occasion14/28 (50.0)Number of physicians with more than two episodes of suboptimal discharge antimicrobial prescription10 (4.0)Supplementary Table 7. Diagnosis for discharge antimicrobial prescriptions in the ED (N=2,835)Physician’s diagnosisPre-intervention period(N=1,555)Per 1,000 visitsInterventionperiod(N=1,280)Per 1,000 visits Sinusitis 34 (2.2)0.918 (1.4)0.5 Pharyngitis103 (6.6)2.896 (7.5)2.8 Acute tonsillitis 19 (1.2)0.534 (2.7)1.0 Other upper respiratory tract infections 10 (0.6)0.2 1 (0.1)0.03 Acute otitis media 42 (2.7)1.224 (1.9)0.7 Acute otitis externa 8 (0.5)0.22(0.2)0.06 Odontogenic infection 18 (1.2)0.531 (2.4)0.9 Neck infection 1 (0.1) 0.031 (0.1)0.03 Bronchitis 23 (1.5)0.711 (0.9)0.3 Asthma attack2 (0.1) 0.061 (0.1)0.03 Pneumonia277 (17.8)7.6216 (16.9) 6.4 COPD exacerbation7 (0.5)0.220 (1.6) 0.6 Urinary tract infection213 (13.7)5.9210 (16.4) 6.2 Sexually transmitted disease22 (1.4)0.617 (1.3) 0.5 Other genitourinary infections 9 (0.6)0.28 (0.6) 0.2 Skin and soft tissue infection233 (15.0)6.4267 (20.9) 7.9 Prophylaxis for wound infection after traumatic injury162 (10.4)4.561 (4.8) 1.8 Animal bite90 (5.8)2.589 (7.0) 2.6 Intra-abdominal infection118 (7.6)3.299 (7.8) 3.0 Gastroenteritis38 (2.4)1.013 (1.0) 0.4“Just in case use” despite low likelihood of bacterial infection 92 (5.9)2.540 (3.1) 1.2 Febrile neutropenia6 (0.4)0.24 (0.3)0.12Others *28 (1.8)0.817 (1.3)0.5NOTE.Data are presented as a number (%) unless otherwise specified.Abbreviations: COPD, chronic obstructive pulmonary disease* Others include miscellaneous bacterial infections (N=9 in the pre-intervention period, N=11 in the intervention period), sialadenitis (N=7, N=3), lymphangitis (N=6, N=0), bursitis (N=4, N=3), and septic arthritis (N=2, N=0). Supplementary Figure 1. Description of the study population.References ADDIN EN.REFLIST 1.Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. Apr 2012;54(8):e72-e112.2.Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician. Mar 01 2009;79(5):383-390.3.Group ESTG, Pelucchi C, Grigoryan L, et al. Guideline for the management of acute sore throat. Clin Microbiol Infect. Apr 2012;18 Suppl 1:1-28.4.Neff MJ, American Academy of P, American Academy of Family P. AAP, AAFP release guideline on diagnosis and management of acute otitis media. Am Fam Physician. Jun 01 2004;69(11):2713-2715.5.National Institute for Health and Care Execellence Otitis media (acute): antimicrobial prescribing (NICE Guideline 91). 2018.6.Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. Mar 01 2007;44 Suppl 2:S27-72.7.Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. Mar 01 2017;195(5):557-582.8.Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. Mar 01 2011;52(5):e103-120.9.Riddle MS, DuPont HL, Connor BA. ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults. Am J Gastroenterol. May 2016;111(5):602-622.10.Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. Jan 15 2010;50(2):133-164.11.Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis. Jul 15 2014;59(2):147-159.12.Hoff WS, Bonadies JA, Cachecho R, Dorlac WC. East Practice Management Guidelines Work Group: update to practice management guidelines for prophylactic antibiotic use in open fractures. J Trauma. Mar 2011;70(3):751-754.13.Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines. J Miss State Med Assoc. Dec 2015;56(12):372-375.14.Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. Feb 15 2011;52(4):e56-93.15.Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011. JAMA. May 3 2016;315(17):1864-1873.16.Spivak ES, Cosgrove SE, Srinivasan A. Measuring Appropriate Antimicrobial Use: Attempts at Opening the Black Box. Clin Infect Dis. Dec 15 2016;63(12):1639-1644.17.Gyssens IC, van den Broek PJ, Kullberg BJ, Hekster Y, van der Meer JW. Optimizing antimicrobial therapy. A method for antimicrobial drug use evaluation. The Journal of antimicrobial chemotherapy. Nov 1992;30(5):724-727. ................
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