Patient and provider characteristics and outcomes associated with outpatient antibiotic overuse in acute adult bronchitis

Abstract

Nonbacterial acute bronchitis leads to many outpatient clinic visits in the US that result in an antibiotic prescription. Understanding antibiotic prescribing patterns and their clinical consequences will help improve antimicrobial stewardship efforts. A retrospective chart review was conducted to identify any correlations between patient and provider characteristics with antibiotic use in adult acute bronchitis (AAB) and to compare the clinical outcomes and rates of health care utilization between those who did and did not receive antibiotics. Study participants included adults with uncomplicated AAB seen by family medicine or internal medicine, specialty, and mid-level practitioners in a Baylor Scott & White Health outpatient facility. Phase 1 investigated whether prescribing rates varied by provider-or patient-level characteristics. Phase 2 compared clinical outcomes and health care utilization between patients who received an antibiotic versus those who did not receive an antibiotic for AAB. Among 35,383 visits for AAB, 81.4% resulted in a prescription for an antibiotic. Physicians >35 years of age and internal and family medicine physicians were more likely to prescribe antibiotics. Health care utilization rates did not differ between cohorts. The number of Clostridium difficile events was negligible. KEYWORDS Acute bronchitis; community-acquired Clostridium difficile; health care utilization; outpatient antibiotics; upper respiratory tract infection A cute respiratory tract infections are the leading drivers in outpatient visits in the US. 1 Nearly 68 million outpatient visits for this diagnosis per year result in an antibiotic prescription, and 50% of those antibiotics may be unnecessary. 2 Uncomplicated adult acute bronchitis (AAB) is diagnosed after ruling out risk factors such as asthma, chronic obstructive pulmonary disease, heart failure, and pneumonia in patients with productive or nonproductive cough lasting up to 6 weeks. 3 Evidence from 40 years of studies has shown the lack of efficacy of antibiotics in AAB, 4,5 as bacteria are detected in only 1% to 10% of AAB cases. 3 Thus, professional societies and medical organizations strongly recommended against antibiotic use in uncomplicated AAB. 2,3 6-9 Despite this, antibiotics were still prescribed in about 70% of AAB visits from 1996 to 2010,

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

“…Previous studies have assessed what provider characteristics predict unnecessary or inappropriate prescribing. Similar to several prior studies [ 35 , 36 ], we found that providers who had spent more years in practice were more likely to give unnecessary prescriptions. In addition, providers in rural settings compared with urban settings were more likely to provide unnecessary antibiotic prescriptions, as seen in studies conducted in different geographic regions [ 37 , 38 ].…”

Development and validation of antibiotic stewardship metrics for outpatient respiratory tract diagnoses and association of provider characteristics with inappropriate prescribing

“…Prior studies have identified provider demographics to be associated with higher proportion of antibiotic prescribing or with surrogate metrics of inappropriateness, including female gender (compared to male), APP (compared to physician), family medicine specialty (compared to pediatrician and internal medicine), older age (compared to younger), nonurban practice setting (compared to urban), and southern United States geographic region (compared to western). [21][22][23][24][25][26][27][28][29][30][31][32][33] All of the characteristics that could be assessed in this study had similar associations to prior studies except for time in practice. In this study, less time in practice was associated with a higher proportion of inappropriate antibiotic prescribing, whereas in other studies older providers were associated with higher proportion of inappropriate antibiotic prescribing.…”

Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, Tennessee

“…Prior studies have shown that both of these factors are associated with differences in antibiotic prescribing practices. 36 Finally, the study period reflects clinical viral testing and antibiotic prescribing and administration practices prior to the coronavirus disease 2019 (COVID-19) pandemic. Studies have recently reported that during the COVID-19 pandemic, changes in healthcare-seeking behaviors (ie, decreases in visits) led to a dramatic reduction of antibiotic prescriptions (31.6 to 6.4 prescriptions per 1,000 visits) in children for respiratory tract infections 37 ; however, from April to June 2021, studies have shown a rebound in both respiratory tract infections and antibiotic prescriptions.…”