Antibiotic use for viral acute respiratory tract infections remains common

Abstract

Objectives: To determine the type and number of antibiotic prescriptions filled in the 28 days following an index visit for acute respiratory tract infections (ARTIs) generally presumed to be viral.

Study design: This was a secondary analysis of administrative data.

Methods: We linked administrative data for pharmacy, clinical encounters, and providers to identify all prescriptions for a relevant antibiotic filled within 28 days of an index visit for an ARTI. Data were analyzed descriptively. The primary outcome was whether or not the patient was prescribed an antibiotic or anti-influenza medication for an episode of presumed viral ARTI.

Results: There were 54,656 encounters for presumed viral ARTI. Most visits (84.4%) were to a primary care clinician, with 12% to an urgent care center and 3.6% to the emergency department. Within 28 days of an encounter for a presumed viral upper respiratory tract infection, 49.4% of patients filled an initial antibiotic prescription, 4.8% a prescription for an anti-influenza drug, and 1.2% received both. A second antibiotic prescription was filled after the initial prescription by 8.9% of patients, and a third by 0.7%. Antibiotic use was most common for acute bronchitis (67.8%) and in the urgent care setting (60.2%). Antibiotics were prescribed less often by pediatricians, whereas anti-influenza medications were prescribed most often for patients aged 5 to 17 years by both pediatricians and family physicians. Antibiotic use has increased since 2007, when azithromycin became a generic drug.

Conclusions: Prescribing antibiotics for ARTIs that are likely to be viral in origin remains common, despite extensive public health educational efforts.