Antibiotic Prescribing Practices for Upper Respiratory Tract Infections Among Primary Care Providers: A Descriptive Study

Abstract

Background Most antibiotics are prescribed in the ambulatory setting with estimates that up to 50% of use is inappropriate. Understanding factors associated with antibiotic misuse is essential to advancing better stewardship in this setting. We sought to assess the frequency of unnecessary antibiotic use for upper respiratory infections (URIs) among primary care providers and identify patient and provider characteristics associated with misuse. Methods Unnecessary antibiotic prescribing were assessed in a descriptive study by using adults ≥ 18 years seen for common URIs in a Large Upper Midwest integrated health system, electronic medical records from June 2017 through May 2018. Individual provider rates of unnecessary prescribing were compared for primary care providers practicing in the departments of internal medicine, family medicine, or urgent care. Patient and provider characteristics associated with unnecessary prescribing were identified with a Logistic regression model. Results 49,463 patient encounters were included. Overall, antibiotics were prescribed unnecessarily for 42.2% (95% CI: 41.7-42.6) of the encounters. Patients with acute bronchitis received unnecessary antibiotics most frequently (74.2%, 95% CI: 73.4-75.0). Males and older patients were more likely to have an unnecessary antibiotic prescription. Provider characteristics associated with higher rates of unnecessary prescribing included being in a rural practice, having more years in practice, and being in higher volume practices such as an urgent care setting. Fifteen percent of providers accounted for half of all unnecessary antibiotic prescriptions. Conclusions Although higher-volume practices, a rural setting, or longer time in practice were predictors, unnecessary prescribing was common among all providers.

Antibiotic prescription for children with acute respiratory tract infections in rural primary healthcare in Guangdong province, China: a cross-sectional study

“…We found that 83% of the children with ARIs were prescribed with antibiotics at the first visit, higher than that reported in Jordan (78.4%) 28. Previous studies have also pointed out that misuse and overuse of antibiotics is not only prominent in children with ARIs, but also common in other groups 29 30. Since 71.67% of the diagnosis were ‘various AURIs of unspecified sites’, we could estimate that most of the antibiotics were prescribed for this diagnosis 31.…”

The Christian Nurse's Role in Antibiotic Stewardship

“…Factors leading to this excess of prescriptions included pressure from patients, limited time of providers to adequately evaluate patients and decide on a course of treatment, uncertain diagnoses (viral vs. bacterial), and the "decision fatigue" physicians experience after treating many patients in a day. Upper respiratory infections are the most frequent diagnosis for which up to 50% of unnecessary prescriptions are written (Deb et al, 2022).…”

Prescription patterns of antibiotics and associated factors among outpatients diagnosed with respiratory tract infections in Jinja City, Uganda, June 2022–May 2023

“…Approximately 30-50% of the global antibiotics consumed are prescribed inappropriately [1][2][3][4]. The antibiotics prescribed for respiratory tract infections unnecessarily constitute 40-80% in low-and middle-income countries (LMICs), [5][6][7]. Studies in Uganda have also revealed a high prevalence of prescription of antibiotics for RTIs (40-80%) which indicates a high level of inappropriate prescription of antibiotics [8,9].…”