Outpatient Antibiotic and Antiviral Utilization Patterns in Patients Tested for Respiratory Pathogens in the United States: A Real-World Database Study

Abstract

This retrospective observational study evaluated outpatient treatment patterns among patients with molecular-based viral diagnostic testing for suspected upper respiratory tract infections in the United States. Patients with a respiratory viral test were identified from 1 August 2016 to 1 July 2019 in a large national reference laboratory database linked to IQVIA's prescription and medical claims databases. Antibiotic and influenza antiviral treatment patterns were reported up to 7 days post-test result. Predictors of antibiotic utilization were assessed using multivariable logistic regression. Among 9561 patients included in the study, 24.6% had evidence of ≥1 filled antibiotic prescription. Antibiotic utilization was higher in patients who tested negative for all viral targets (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.17-1.50) and patients positive for non-influenza viruses (OR, 1.28; 95% CI, 1.09-1.51) compared with those influenza-positive only. Age ≥ 50 years and location outside of the northeast United States also predicted antibiotic utilization. Influenza antivirals were more common in influenza-positive patients compared with patients with other test results (32.5% vs. 3.6-9.0%). Thus, in this real-world study, antibiotic utilization was elevated in patients positive for non-influenza viruses, although antibiotics would generally not be indicated. Further research on pairing diagnostic tools with outpatient antibiotic stewardship programs is needed.

Keywords: antibiotic; antiviral; diagnostics; outpatients; real-world; respiratory tract infections; stewardship.

Figure 1

Patient selection. Abbreviations: CPT, current procedural terminology; Dx, medical claims database; LRx, prescription claims database. * CPT codes included 87,502, 87,631, 87,632, and 87,633. ^† A patient is considered to have pharmacy stability if ≥1 visited pharmacy consistently supplies data for the 6-month baseline and 1-month follow-up period (i.e., 7 months of stability).

Figure 2

Utilization of antibiotics and influenza antivirals on or after receipt of the index test result in the study cohort stratified by test result. Abbreviations: RSV, respiratory syncytial virus; hMPV, human metapneumovirus. Test result categories are not mutually exclusive. Subgroups of any non-influenza virus are based on tests listed in Supplemental Figure S1. Influenza includes “influenza A virus”, “influenza B virus”, “influenza A subtype H1”, and “influenza A subtype H3”. RSV includes “respiratory syncytial virus”, “respiratory syncytial virus A”, and “respiratory syncytial virus B”. Parainfluenza virus includes “parainfluenza virus 1”, “parainfluenza virus 2”, “parainfluenza virus 3”, “parainfluenza virus 4”, and “parainfluenza virus, specified and not specified”. Rhinovirus or enterovirus includes “rhinovirus/enterovirus” and “rhinovirus”. Treatment utilization was not reported for the 1 patient with a positive result for “coronavirus, specified and not specified”.