title: Tobacco Smoking as a Risk Factor for Increased Antibiotic Prescription.
abstract: Antibiotic resistance is rapidly spreading, affecting millions of people and costing billions of dollars. Potential factors affecting antibiotic prescription, such as tobacco use, could dramatically influence this public health crisis. The study determined the magnitude of impact that tobacco use has on antibiotic prescribing patterns.
  
  
  
  Pooled data were analyzed in 2015 from the 2006-2010 National Ambulatory Medical Care Survey, a cross-sectional survey describing use of ambulatory medical services in the U.S. via healthcare provider-patient encounters. Patients aged >18 years with documented tobacco use status diagnosed with an infection were included (i.e., all encounters in the analysis included an infectious diagnosis of interest). The analytic sample included 8,307 visits, representing 294 million visits nationally.
  
  
  
  Half (49.9%) of encounters that included any infection had an antibiotic prescribed. Adjusted odds of receiving antibiotics among current tobacco users was 1.20 (95% CI=1.02, 1.42), and even higher for encounters of respiratory infections (AOR=1.31, 95% CI=1.05, 1.62). Antibiotic prescription rates were lower among patients aged >65 years, those with comorbid asthma or cancer, non-whites, and those covered by Medicaid and higher for primary care physicians.
  
  
  
  Despite lack of evidence-based rationale, among a national sample of patients with an infectious diagnosis, tobacco users had 20%-30% higher odds of receiving antibiotics than non-tobacco users. This is the first U.S. study to quantify the magnitude of this unsubstantiated practice. Prescribers should understand that tobacco use could be associated with higher antibiotic prescription, which may subsequently increase antimicrobial resistance in the community.
authors.affiliation: Rutgers Robert Wood Johnson Medical School, Division of General Internal Medicine, New Brunswick, New Jersey; Rutgers School of Public Health, Department of Health Education and Behavioral Science, New Brunswick, New Jersey; Rutgers Cancer Institute of New Jersey, Population Science Section, New Brunswick, New Jersey. Electronic address: michael.steinberg@rutgers.edu.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Steinberg
authors.affiliation: Rutgers School of Social Work, New Brunswick, New Jersey; Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey.
authors.forename: Ayse
authors.initials: A
authors.lastname: Akincigil
authors.affiliation: Rutgers Ernest Mario School of Pharmacy, Piscataway, New Jersey.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Kim
authors.affiliation: Rutgers Robert Wood Johnson Medical School, Division of General Internal Medicine, New Brunswick, New Jersey.
authors.forename: Rory
authors.initials: R
authors.lastname: Shallis
authors.affiliation: Rutgers School of Public Health, Department of Health Education and Behavioral Science, New Brunswick, New Jersey; Rutgers Cancer Institute of New Jersey, Population Science Section, New Brunswick, New Jersey.
authors.forename: Cristine D
authors.initials: CD
authors.lastname: Delnevo
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents