Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care

Abstract

Objective: To determine independent risk factors for inappropriate antibiotic prescribing for acute respiratory tract infections (ARIs) in internal medicine (IM) residencyebased primary care offices. Patients and Methods: A retrospective study was conducted to measure antibiotic prescribing rates, and multivariable analysis was utilized to identify predictors of inappropriate prescribing among patients presenting to IM residencyebased primary care office practices. Patients with an office visit at either of 2 IM residencyebased primary care office practices from January 1, 2016, through December 31, 2016, with a primary encounter diagnosis of ARI were included. Results: During the study period, 911 unique patient encounters were included with 518 for conditions for which antibiotics were considered always inappropriate. Antibiotics were not indicated in 85.8% (782 of 911) of encounters. However, antibiotics were prescribed in 28.4% (222 of 782) of these encounters. Inappropriate antibiotic prescribing occurred in 111 of 518 (21.4%) encounters for conditions for which antibiotics are always inappropriate. Using multivariable logistic regression analysis to assess for independent risk factors when adjusted for other potential risk factors for office visits at which antibiotics were not indicated, IM residenteassociated visits (odds ratio, 0.25; 95% CI, 0.18-0.36) was the only variable independently associated with lower risk of inappropriate antibiotic prescribing.

Antimicrobial prescribing practices at a tertiary-care center in patients diagnosed with COVID-19 across the continuum of care

“…to benefit from antimicrobials and found prescribing rates of 21%. 15,16 Factors that influence inappropriate prescribing of antimicrobials include diagnostic uncertainty, time pressures, and perception of patient pressure antimicrobial prescribing. 17 A potential hypothesis for our low rate of antimicrobial prescribing in the outpatient setting is that ambulatory encounters involved cases that were milder, for which the positive RT-PCR provided a level of diagnostic certainty, and for which timerelated and patient-driven antibiotic prescribing pressures may have been reduced given virtual or telephone follow-up.…”

Provider views on rapid diagnostic tests and antibiotic prescribing for respiratory tract infections: A mixed methods study

“…Respiratory tract infections (RTIs) account for approximately 60% of antibiotic prescriptions in the outpatient setting [ 1 , 2 ] although the majority of RTIs are viral [ 2 – 4 ], and antibiotic treatment is not indicated [ 3 , 5 , 6 ]. One-third to one-half of acute RTIs in adults are inappropriately treated with antibiotics [ 7 – 10 ] with acute bronchitis and acute sinusitis accounting for a large proportion of those [ 6 , 11 , 12 ].…”

“…Pediatric patients with viral infections such as bronchitis and bronchiolitis are often given antibiotics, even in the absence of bacterial infection [ 14 , 15 ]. Inappropriate prescribing promotes antibiotic resistance and increases healthcare costs [ 2 , 16 ]. In addition, antibiotics are frequently associated with side effects for patients [ 16 , 17 ].…”

Drug use evaluation of cefepime at Khartoum North Teaching Hospital in Sudan

“…The global irrational use of antibiotics is the principal cause of antibiotic resistance. Recently, there are increasing concerns regarding the appropriate use of antibiotics 24,25 . In general, antibiotics were inappropriately prescribed in developing countries including Sudan 26‐28 .…”

“…Recently, there are increasing concerns regarding the appropriate use of antibiotics. 24,25 In general, antibiotics were inappropriately prescribed in developing countries including Sudan. [26][27][28] In Sudan, only one-quarter of antibiotics were prescribed according to the national guidelines, and over-utilisation of antibiotics results in the emergence of the resistant strain.…”