January 22, 2014
EDs Too Often Prescribe Antibiotics to Adults Presenting With Acute Respiratory Infections

Birmingham, AL—Adults continue to get too many antibiotic prescriptions when they present with acute respiratory tract infections at U.S. emergency departments, according to a new study.

That is despite successful efforts to curb antibiotic prescribing for younger patients with the same complaints, according to the article published ahead of print in the journal Antimicrobial Agents and Chemotherapy.

For the study, researchers employed data from the National Hospital Ambulatory Medical Care Survey for 2001-2010, a period that included 126 million visits to U.S. emergency departments with acute respiratory tract infections. Antibiotics were prescribed in 61% of those cases.

“While emergency department antibiotic use for acute respiratory tract infections decreased in the past decade among children, we saw no decrease in antibiotic use for adults with acute respiratory tract infections,” explained co-author John Baddley, MD, MSPH, of the University of Alabama at Birmingham. “Given organized efforts to emphasize antibiotic stewardship, we expected to see a decrease in emergency department antibiotic use for such infections.”

Researchers classified diagnoses as antibiotic-appropriate—otitis media, sinusitis, pharyngitis, tonsillitis, and non-viral pneumonia—or antibiotic-inappropriate: nasopharyngitis, unspecified upper respiratory tract infection, bronchitis or bronchiolitis, viral pneumonia, and influenza.

“Between 2001 and 2010, antibiotic utilization decreased for patients aged <5 presenting with antibiotic-inappropriate ARTI (RR 0.94; CI 0.88-1.00). Utilization also decreased significantly for antibiotic-inappropriate ARTI patients aged 5-19 years (RR 0.89; CI 0.85-0.94). Utilization remained stable for antibiotic-inappropriate ARTI among adult patients aged 20-64 years (RR 0.99; CI 0.97-1.01),” according to study authors, who added that, for adults, “rates of quinolone use for ARTI increased significantly from 83 per 1,000 visits in 2001-2002 to 105 per 1,000 in 2009-2010 (RR 1.08; CI 1.03-1.14).”

Baddley pointed out that reducing inappropriate antibiotic prescribing in the ED could have significant benefit since so many primary care patients are treated in that setting.

Acute respiratory tract infections—such as rhinitis, sinusitis, and bronchitis—account for nearly a tenth of ambulatory care visits in the U.S. Although viruses often cause the infections, clinicians persist in prescribing antibacterials, the study notes, which can foster antibiotic resistance.

“The observed lack of change in antibiotic utilization for adult acute respiratory tract infection patients, especially those with infections where antibiotics are not indicated, is concerning," according to the authors. "This may indicate that efforts to curtail inappropriate antibiotic use have not been effective or have not yet been implemented for this subset of patients.”

Some of the factors leading to inappropriate antibiotic use, according to the investigators, are difficulties in making a definitive diagnosis and pressure from patients to get an antibiotic prescription.

“Although significant progress has been made toward reduction of antibiotic utilization for pediatric patients with ARTI, the proportion of adult ARTI patients receiving antibiotics in U.S. EDs is inappropriately high. Institution of measures to reduce inappropriate antibiotic use in the ED setting is warranted,” study authors conclude.

U.S. Pharmacist Social Connect