title: Poor congruence with guidelines in the use of antibiotics for acute bronchitis: a descriptive study based on electronic health records.
abstract: Although acute bronchitis is frequently viral in nature, antibiotics are usually inappropriately prescribed in Primary Care to treat this condition, with serious public health consequences.
  
  
  
  To determine the prevalence and predictors of appropriate management of antibiotic use in acute bronchitis processes diagnosed in outpatients in the Spanish region of Aragón.
  
  
  
  Four different electronic health databases provided demographic and clinical information pertaining to patients diagnosed with acute bronchitis in Primary Care in Aragón during 2011, as well as data for corresponding antibiotic prescriptions dispensed at pharmacies. We evaluated adherence to recommendations for antibiotic use in acute bronchitis episodes in adults collected in both international and national guidelines. Finally, regression analyses were used to identify factors associated with appropriate antibiotic management.
  
  
  
  A total of 54701 episodes of acute bronchitis were registered, 9.5% of which corresponded to patients with an underlying chronic respiratory disease. In adults, antibiotics were prescribed in 64.9% of episodes, 17.9% of which involved prescription of a first-choice agent. Overall, 48.5% of episodes were appropriately managed according to guidelines. The likelihood of appropriate treatment was higher for female patients, and lower for patients who were older, presented chronic co-morbidities or were using corticoids.
  
  
  
  We observed poor levels of adherence to recommendations for antibiotic prescribing in adults with acute bronchitis, in terms of both the decision to prescribe and the choice of antibiotic agent. Older acute bronchitis patients and those with co-morbidities were at greater risk of being inappropriately treated.
authors.affiliation: Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain, Health Services Research Group in Aragón (GRISSA), Spain, smalo@unizar.es.
authors.forename: Sara
authors.initials: S
authors.lastname: Malo
authors.affiliation: Health Services Research Group in Aragón (GRISSA), Spain, EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain and Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Poblador-Plou
authors.affiliation: Health Services Research Group in Aragón (GRISSA), Spain, EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain and Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Prados-Torres
authors.affiliation: Health Services Research Group in Aragón (GRISSA), Spain, Pharmacy Service in Primary Health Care, Aragon Health Service, Zaragoza, Spain.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Lallana
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain and.
authors.forename: Clara
authors.initials: C
authors.lastname: Laguna-Berna
authors.affiliation: Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain, Health Services Research Group in Aragón (GRISSA), Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Rabanaque
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001991:Bronchitis / Q000188:drug therapy*; D015897:Comorbidity; D016208:Databases, Factual; D004363:Drug Utilization / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D011320:Primary Health Care; D012044:Regression Analysis; D013030:Spain; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute bronchitis; Primary Care; antibacterial agents; guideline adherence; respiratory tract infection.