Atlanta—Acute respiratory infection (ARI) is the most common diagnosis for which antibiotics are prescribed. Yet viruses cause most of these conditions, for which the drugs are not effective, a new study notes.

The report in JAMA Network Open determined that 41% of almost 15,000 outpatients with acute respiratory infection were prescribed antibiotics, and 41% of them had diagnoses not requiring the medications.

Researchers from the CDC said the diagnoses were primarily viral upper respiratory tract infections and bronchitis, but that 29% of patients with influenza confirmed through research testing also were prescribed antibiotics. Of those who received the prescriptions, 38% with pharyngitis tested negative for group A streptococcus, and 38% with sinusitis had symptoms for 3 days or fewer before the visit, suggesting antibiotic therapy was not required in either of the situations.

“Eliminating antibiotic treatment of viral upper respiratory tract infections and bronchitis, improving influenza diagnosis and treatment, and reinforcing prescription guidelines for pharyngitis and sinusitis could improve outpatient antibiotic stewardship,” study authors emphasize.

The cohort study enrolled outpatients aged 6 months or older with ARI evaluated at outpatient clinics associated with five U.S. Influenza Vaccine Effectiveness Network sites during the 2013–2014 and 2014–2015 influenza seasons.

All patients who visited the clinics for a cough of 7 days duration or less received influenza testing by real-time reverse transcriptase–polymerase chain reaction for research purposes only. Medical and pharmacy records were used to determine antibiotic prescriptions, medical history, and International Classification of Diseases, Ninth Revision diagnosis codes, as well as GAS testing results in a patient subset.

Results included the following:
• Of the 22% of patients not diagnosed as having pneumonia and who had laboratory-confirmed influenza, 29% were prescribed an antibiotic, accounting for 17% of all antibiotic prescriptions among patients with nonpneumonia ARI.
• In 91% of patients with pharyngitis who underwent GAS testing for group A strep, 35% were prescribed antibiotics, among whom more than a third had negative results on GAS testing.
• Of those getting an antibiotic prescription even though they had sinusitis and no other indication for anything more serious, 38% had symptoms for 3 days or fewer prior to the outpatient visit, suggesting acute viral sinusitis not requiring antibiotics.

“Antibiotic overuse remains widespread in the treatment of outpatient ARIs, including among patients with laboratory-confirmed influenza, although study sites may not be representative of other outpatient settings,” study authors conclude.

The researchers also suggested that “increased access to sensitive and timely virus diagnostic tests, particularly for influenza, may reduce unnecessary antibiotic use for these syndromes.”

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