This article is more than 5 years old. Information may no longer be current.
Antibiotic prescriptions for acute respiratory infections remain high, vary among providers
Click Here to Manage Email Alerts
Health care providers frequently prescribed antibiotics to veterans with acute respiratory infections regardless of patient characteristics and clinical setting, according to recent data published in the Annals of Internal Medicine.
However, the number of antibiotic prescriptions for acute respiratory infections varied among providers.
“The lack of progress in reducing unnecessary antibiotic prescribing for [acute respiratory infection] is a major public health concern,” Barbara Ellen Jones, MD, MSc, from the George E. Wahlen Department of Veterans Affairs Medical Center, and colleagues wrote.
Jones and colleagues examined electronic health records from more than 1 million patient visits at 990 clinics or EDs at 130 VA medical centers in the United States between January 2005 and December 2012. Patients (median age, 61) included in the analysis were primarily diagnosed with ARI and had generally low bacterial concentrations.
Overall, the frequency of antibiotic prescriptions increased from 67.5% in 2005 to 69.2% in 2012 (P < .001), according to the results. The antibiotic trend over the course of the study showed an increase in macrolide prescriptions (36.8% to 47%) and a decrease in penicillins (36% to 32.1%) and fluoroquinolones (15% to 12.7%).
“This trend is concerning given the lack of additional benefit of macrolides over narrow-spectrum antibiotics for [acute respiratory infection] treatment,” Jones and colleagues wrote.
Nearly 70% of patients were prescribed antibiotics for acute respiratory infections. A higher prevalence of antibiotic prescription was seen among patients diagnosed with sinusitis (86%), bronchitis (85%), and high fever (78%). In addition, antibiotics were more frequently prescribed in an urgent care setting (75%), the southern region (71%) and the central region (71%), and also in VA medical center-based clinics than community-based outpatient clinics (70% vs. 64%).
The researchers limited data to 2,594 providers who saw at least 100 patients with acute respiratory infections (n = 480,875 visits) and found that 10% of the providers prescribed at least 95% of their patients antibiotics. In contrast, 10% of providers on the other end of the spectrum prescribed antibiotics to 40% or fewer of patients.
The researchers concluded that variation in antibiotic prescription was substantial at the provider level and was not influenced by confounding factors, including temperature, distance to clinic, setting type and geographic region.
“Our findings suggest that providers have a strong tendency to choose the same treatment regardless of patient or clinic characteristics, indicating that individual provider preference or ‘style’ heavily influences the antibiotic decision,” Jones and colleagues wrote. – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts