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Age, race associated with receipt of inappropriate antibiotics
A patient’s race and age are both associated with the prescription of inappropriate antibiotics for viral upper respiratory illnesses, according to findings recently published in Infection Control & Hospital Epidemiology.
“To combat increasing resistance to available antibiotics, the White House released a National Action Plan in 2015 that set a goal of reducing inappropriate outpatient antibiotic use by 50% by 2020. Since that time, several studies have been published that describe baseline prescribing rates in outpatient practices,” Lisa Davidson, MD, medical director of the Antimicrobial Support Network at Carolinas HealthCare System, and colleagues wrote. “...Few studies have included practice types, provider and patient characteristics to determine their impact on antimicrobial prescribing for common indications in the ambulatory care space.” Davidson and colleagues performed a retrospective cohort study, reviewing data from 448,990 outpatient visits to urgent care, family medicine, pediatric and internal medicine practices from January 2014 to May 2016. All visits included in the study focused on common upper respiratory ailments, none of which were expected to require antibiotics. The researchers reported prescription rates per 1,000 visits and used multivariable models to calculate the risk of receiving an antibiotic prescription.
There were 407 (95% CI, 405-408) prescriptions per 1,000 visits, Davidson and colleagues reported. Patients who received care from an advanced practice practitioner, such as a physician assistant or nurse practitioner, were 15% more likely to be prescribed an antibiotic compared with those who were seen by a physician (IRR = 1.15; 95% CI, 1.03-1.29).
In a model adjusted to include only adults, white patients were more likely than patients of all other races to receive antibiotics, Davidson and colleagues reported. Age also played a role. Patients aged 20 to 39 years were 4% less likely to be prescribed an antibiotic than those aged 40 to 64 years (IRR = 1.04; 95% CI, 1.02-1.05).
In pediatrics, the age of the care provider significantly influenced prescription practices. Providers aged 51 to 60 years were four times more likely to prescribe antibiotics to children than those who were aged 30 years or younger, the researchers wrote (IRR = 4.21; 95% CI, 2.96-5.97). However, this risk began to fall when providers were aged 60 years or older (IRR = 2.96; 95% CI, 2.12-4.13).
“By undertaking this research, we can help ensure that our local patients receive the most appropriate, safe care, and are not inappropriately prescribed antibiotics,” Davidson said in a press release. “These results also show that strategies to reduce inappropriate prescribing must be tailored for outpatient settings.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.