title: Factors associated with antibiotic misuse in outpatient treatment for upper respiratory tract infections.
abstract: The Centers for Disease Control and Prevention has promoted the appropriate use of antibiotics since 1995 when it initiated the National Campaign for Appropriate Antibiotic Use in the Community. This study examined upper respiratory tract infections included in the campaign to determine the degree to which antibiotics were appropriately prescribed and subsequent admission rates in a veteran population. This study was a retrospective chart review conducted among outpatients with a diagnosis of a respiratory tract infection, including bronchitis, pharyngitis, sinusitis, or nonspecific upper respiratory tract infection, between January 2009 and December 2011. The study found that 595 (35.8%) patients were treated appropriately, and 1,067 (64.2%) patients received therapy considered inappropriate based on the Get Smart Campaign criteria. Overall the subsequent readmission rate was 1.5%. The majority (77.5%) of patients were prescribed an antibiotic. The most common antibiotics prescribed were azithromycin (39.0%), amoxicillin-clavulanate (13.2%), and moxifloxacin (7.5%). A multivariate regression analysis demonstrated significant predictors of appropriate treatment, including the presence of tonsillar exudates (odds ratio [OR], 0.6; confidence interval [CI], 0.3 to 0.9), fever (OR, 0.6; CI, 0.4 to 0.9), and lymphadenopathy (OR, 0.4; CI, 0.3 to 0.6), while penicillin allergy (OR, 2.9; CI, 1.7 to 4.7) and cough (OR, 1.6; CI, 1.1 to 2.2) were significant predictors for inappropriate treatment. Poor compliance with the Get Smart Campaign was found in outpatients for respiratory infections. Results from this study demonstrate the overprescribing of antibiotics, while providing a focused view of improper prescribing. This article provides evidence that current efforts are insufficient for curtailing inappropriate antibiotic use.
authors: VA Western New York Healthcare System, Infectious Diseases and Pharmacy Departments, Buffalo, New York, USA.
authors: Jennifer L
authors: JL
authors: Schroeck
authors: VA Western New York Healthcare System, Infectious Diseases and Pharmacy Departments, Buffalo, New York, USA.
authors: Christine A
authors: CA
authors: Ruh
authors: VA Western New York Healthcare System, Infectious Diseases and Pharmacy Departments, Buffalo, New York, USA University at Buffalo, School of Medicine, Buffalo, New York, USA.
authors: John A
authors: JA
authors: Sellick
authors: Erie County Medical Center, Pharmacy Department, Buffalo, New York, USA.
authors: Michael C
authors: MC
authors: Ott
authors: VA Western New York Healthcare System, Infectious Diseases and Pharmacy Departments, Buffalo, New York, USA East Orange VA, East Orange, New Jersey, USA.
authors: Arun
authors: A
authors: Mattappallil
authors: VA Western New York Healthcare System, Infectious Diseases and Pharmacy Departments, Buffalo, New York, USA kari.mergenhagen@va.gov.
authors: Kari A
authors: KA
authors: Mergenhagen
mesh_terms: D000553:Ambulatory Care; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D002487:Centers for Disease Control and Prevention, U.S.; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D015999:Multivariate Analysis; D010045:Outpatients; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012189:Retrospective Studies; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D019980:Amoxicillin-Potassium Clavulanate Combination; D017963:Azithromycin; D000077266:Moxifloxacin