Antibiotic Utilization for Acute Respiratory Tract Infections in U.S. Emergency Departments

Abstract

Inappropriate use of antibiotics for acute respiratory tract infections (ARTIs) has decreased in many outpatient settings. For patients presenting to U.S. emergency departments (EDs) with ARTIs, antibiotic utilization patterns are unclear. We conducted a retrospective cohort study of ED patients from 2001 to 2010 using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). We identified patients presenting to U.S. EDs with ARTIs and calculated rates of antibiotic utilization. Diagnoses were classified as antibiotic appropriate (otitis media, sinusitis, pharyngitis, tonsillitis, and nonviral pneumonia) or antibiotic inappropriate (nasopharyngitis, unspecified upper respiratory tract infection, bronchitis or bronchiolitis, viral pneumonia, and influenza).There were 126 million ED visits with a diagnosis of ARTI, and antibiotics were prescribed in 61%. A cute respiratory tract infections (ARTIs) such as bronchitis, sinusitis, and rhinitis account for almost 10% of ambulatory care visits in the United States (1). While many of these infections are caused by viruses, clinicians prescribe antibiotics for over half of the visits for these conditions (1, 2). This inappropriate antibiotic use is potentially harmful to the community, fostering the growth of antimicrobial-resistant organisms (3). Other potential consequences include antibiotic-related adverse effects, such as Clostridium difficile-associated disease, antibiotic-associated diarrhea, and allergic reactions (4-6). Over the past decade, multiple campaigns and interventions have sought to curtail the use of inappropriate antibiotics for ARTIs, focused primarily on outpatient visits. There is evidence of improvement, with ARTI antibiotic prescription rates decreasing among young children and reduction of rates of broad-spectrum antimicrobial use in older persons (1,2,7,8).Much less is known about patterns of antibiotic use for ARTIs among persons visiting emergency departments (EDs). ED use in the United States has increased over the past decade, and Americans rely increasingly on EDs for a wide range of medical conditions due to a combination of barriers to primary care access (9, 10). As a result, the ED has become a common site of care for nonemergent conditions, including ARTIs, particularly among socioeconomically disadvantaged individuals.We sought to characterize antibiotic utilization for ARTIs treated in U.S. emergency departments with the use of national surveillance data. MATERIALS AND METHODSStudy design and data source. We analyzed 2001-to-2010 data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). The study was approved by the Institutional Review Board of the University of Alabama at Birmingham.Operated by the National Center for Health Statistics, NHAMCS is a national probability sample characterizing ED (NHAMCS-ED) and outpatient clinic visits at hospitals across the United States (11). Using a four-stage probability design, NHAMCS-ED samples geographically defined areas, hospitals within these areas, emergenc...

Effect of a Health Care System Respiratory Fluoroquinolone Restriction Program To Alter Utilization and Impact Rates of Clostridium difficile Infection

“…Respiratory fluoroquinolones have been shown to be overused for indications in which other antimicrobials are more appropriate or for which antibiotics are not indicated, such as in the case of treatment of acute exacerbations of chronic bronchitis (19,20). This is especially important given the increased resistance with fluoroquinolones and a strong association with onset of CDI (6)(7)(8)(9).…”

Use of Rapid Influenza Testing to Reduce Antibiotic Prescriptions Among Outpatients with Influenza-Like Illness in Southern Sri Lanka

“…1,2 Although the majority of ARTIs are caused by viruses such as rhinovirus, adenovirus, influenza, and respiratory syncytial virus, ARTIs are one of the most common reasons for being prescribed an antibiotic in the outpatient setting. [3][4][5] In the United States, over half of outpatient visits for ARTIs result in an antibiotic prescription, with up to 55% of these prescriptions being unnecessary at an excess cost of $726 million annually. 6,7 Antibiotic overprescription, in addition to contributing to increased health-care costs, is associated with adverse drug reactions and the development of antimicrobial resistance.…”

Substantial Variation in Hospital Rankings after Adjusting for Hospital-Level Predictors of Publicly-Reported Hospital-Associated Clostridium difficile Infection Rates

“…We used 2010 mandatory line-item hospitalization data and publicly available data to summarize patient population and hospital characteristics.5 Consistent with prior work evaluating publicly reported HAIs and C. difficile colitis,4,6 we determined hospital type (eg, teaching, community, LTAC, pediatric), the number of licensed beds, and the percentage of admissions with select characteristics including age, gender, race, insurance, length-of-stay, admission and discharge location, surgery, and administrative codes involving any infection as a surrogate for antibiotic use. 7,8 Comorbidities were assessed using the Romano score, a validated comorbidity index. 9 We evaluated the percent of inpatients living in zip codes with the lowest quartile of education attainment and income and the highest quartile of poverty (% living below federal poverty level), overcrowding (occupied housing units with >1 person per room), and unemployment compared to the statewide range for the selected attribute using the 2006-2010 US Census American Community Survey.…”