title: Antibiotic treatment of acute respiratory infections in acute care settings.
abstract: 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.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA 94118, USA. ralphg@medicine.ucsf.edu
authors.forename: Ralph
authors.initials: R
authors.lastname: Gonzales
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Thomas
authors.initials: T
authors.lastname: MacKenzie
authors.forename: Ayanna S
authors.initials: AS
authors.lastname: Kersey
authors.forename: Judith
authors.initials: J
authors.lastname: Maselli
authors.forename: Sara K
authors.initials: SK
authors.lastname: Levin
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents