Acute respiratory tract infection: a practice examines its antibiotic prescribing habits.
OBJECTIVE
We wanted to better understand our practice behaviors by measuring antibiotic prescribing patterns for acute respiratory tract infections (ARTIs), which would perhaps help us delineate goals for quality improvement interventions. We determined (1) the distribution of ARTI final diagnoses in our practice, (2) the frequency and types of antibiotics prescribed, and (3) the factors associated with antibiotic prescribing for patients with ARTI.


METHODS
We looked at office visits for adults with ARTI symptoms that occurred between December 14, 2009, and March 4, 2010. We compiled a convenience sample of 438 patient visits, collecting historical information, physical examination findings, diagnostic impressions, and treatment decisions.


RESULTS
Among the 438 patients, cough was the most common presenting complaint (58%). Acute sinusitis was the most frequently assigned final diagnosis (32%), followed by viral upper respiratory tract infection (29%), and acute bronchitis (24%). Sixty-nine percent of all ARTI patients (304/438) received antibiotic prescriptions, with macrolides being most commonly prescribed (167/304 [55%]). Prescribing antibiotics was associated with a complaint of sinus pain or shortness of breath, duration of illness ≥8 days, and specific abnormal physical exam findings. Prescribing rates did not vary based on patient age or presence of risk factors associated with complication. Variations in prescribing rates were noted between individual providers and groups of providers.


CONCLUSIONS
We found that we prescribed antibiotics at high rates. Diagnoses of acute sinusitis and bronchitis may have been overused as false justification for antibiotic therapy. We used broad-spectrum antibiotics frequently. We have identified several gaps between current and desired performance to address in practice-based quality improvement interventions.
Department of Family Medicine, Mayo Clinic, Scottsdale, AZ 85260, USA. grover.michael@mayo.edu
Michael L
ML
Grover
Martina
M
Mookadam
Richard H
RH
Rutkowski
Allison M
AM
Cullan
Destin E
DE
Hill
David C
DC
Patchett
Esan O
EO
Simon
Marilynn
M
Mulheron
Brie N
BN
Noble
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005194:Family Practice / Q000592:standards; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D058996:Quality Improvement; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D055815:Young Adult
D000900:Anti-Bacterial Agents