Antibiotic treatment of acute respiratory infections in acute care settings.
OBJECTIVE
To examine the patterns of antibiotic use for acute respiratory tract infections (ARIs) in acute care settings.


METHODS
Chart reviews were performed retrospectively on a random sample of adult ARI visits to seven Veterans Affairs (VA) and seven non-VA emergency departments (EDs) for the period of November 2003 to February 2004. Visits were limited to those discharged to home and those with primary diagnoses of antibiotic-responsive (pneumonia, acute exacerbation of chronic bronchitis, pharyngitis, sinusitis) and antibiotic-nonresponsive conditions (acute bronchitis, nonspecific upper respiratory tract infection [URI]). Results are expressed as adjusted odds ratios with 95% confidence intervals.


RESULTS
Of 2,270 ARI visits, 62% were for antibiotic-nonresponsive diagnoses. Seventy-two percent of acute bronchitis and 38% of URI visits were treated with antibiotics (p < 0.001). Stratified analyses show that antibiotic prescription rates were similar among attending-only and housestaff-associated visits for antibiotic-responsive diagnoses (p = 0.11), and acute bronchitis (76% vs. 59%; p = 0.31). However, the antibiotic prescription rate for URIs was greater for attending-only visits compared with housestaff-associated visits (48% vs. 15%; p = 0.01). Antibiotic prescription rates for total ARIs varied between sites, ranging from 42% to 89%. Patient age, gender, race and ethnicity, smoking status, comorbidities, and clinical setting (VA vs. non-VA) were not independently associated with antibiotic prescribing.


CONCLUSIONS
Acute care settings are important targets for reducing inappropriate antibiotic prescribing. The mechanisms accounting for lower antibiotic prescription rates observed with housestaff-associated visits merit further study.
Gonzales
Ralph
R
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA 94118, USA. ralphg@medicine.ucsf.edu
Camargo
Carlos A
CA
MacKenzie
Thomas
T
Kersey
Ayanna S
AS
Maselli
Judith
J
Levin
Sara K
SK
McCulloch
Charles E
CE
Metlay
Joshua P
JP
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001249:Asthma / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D044469:Racial Groups / Q000706:statistics & numerical data; D012044:Regression Analysis; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data
D000900:Anti-Bacterial Agents