Outpatient Antibiotic and Antiviral Utilization Patterns in Patients Tested for Respiratory Pathogens in the United States: A Real-World Database Study

Abstract

This retrospective observational study evaluated outpatient treatment patterns among patients with molecular-based viral diagnostic testing for suspected upper respiratory tract infections in the United States. Patients with a respiratory viral test were identified from 1 August 2016 to 1 July 2019 in a large national reference laboratory database linked to IQVIA’s prescription and medical claims databases. Antibiotic and influenza antiviral treatment patterns were reported up to 7 days post-test result. Predictors of antibiotic utilization were assessed using multivariable logistic regression. Among 9561 patients included in the study, 24.6% had evidence of ≥1 filled antibiotic prescription. Antibiotic utilization was higher in patients who tested negative for all viral targets (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.17–1.50) and patients positive for non-influenza viruses (OR, 1.28; 95% CI, 1.09–1.51) compared with those influenza-positive only. Age ≥ 50 years and location outside of the northeast United States also predicted antibiotic utilization. Influenza antivirals were more common in influenza-positive patients compared with patients with other test results (32.5% vs. 3.6–9.0%). Thus, in this real-world study, antibiotic utilization was elevated in patients positive for non-influenza viruses, although antibiotics would generally not be indicated. Further research on pairing diagnostic tools with outpatient antibiotic stewardship programs is needed.

Characteristics of initiators of budesonide/glycopyrrolate/formoterol for treatment of chronic obstructive pulmonary disease (COPD) in the United States: the AURA study

“…To that end, services received from providers and medications filled at pharmacies that are out of the network of data suppliers of the databases were not captured. However, consistent with other studies leveraging the study databases, [28][29][30] standard approaches of ensuring stable data supply and patient activities in the study databases were used as proxies for continuous follow-up. The study data also do not capture inpatient utilization, which may lead to underestimation of COPD exacerbations and prevalence of comorbidities (e.g.…”

Point-of-Care and Rapid Tests for the Etiological Diagnosis of Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis

“…Even if no definite statement can be made, it is interesting to notice that the trend towards fewer prescriptions is stronger in Europe than in the USA. IDSA guidelines for influenza strengthen the efficacy of an empirical antibacterial therapy to be started in case of deterioration or failure to improve in patients with this diagnosis, especially those with comorbidities [ 73 , 74 ]. Moreover, in the US, antimicrobial stewardship programs have been widespread for longer, so the impact of rapid tests and POCTs in further reducing antibiotics may appear less significant.…”

The epidemiology of pediatric outpatient acute respiratory tract infections in the US: a multi-facility analysis of multiplex PCR testing from 2018 to 2023

“…Knowledge of the epidemiology of outpatient pediatric respiratory illness is limited, particularly data after the onset of the circulation of SARS-CoV-2, and is likely different between healthcare settings ( 4 – 6 ). Moreover, general deficits in knowledge of viral epidemiology have been noted such as the Centers for Disease Control and Prevention (CDC) indicating gaps in epidemiology for respiratory syncytial virus (RSV) ( 7 ).…”