Abstract
BackgroundInappropriate antibiotic use promotes resistance. Antibiotics are generally not indicated for upper respiratory infections (URIs). Our objectives were to describe patterns of URI treatment and to identify patient and provider factors associated with antibiotic use for URIs.MethodsThis study was a cross-sectional analysis of medical and pharmacy claims data from the Pennsylvania Medicaid fee-for-service program database. We identified Pennsylvania Medicaid recipients with a URI office visit over a one-year period. Our outcome variable was antibiotic use within seven days after the URI visit. Study variables included URI type and presence of concurrent acute illnesses and chronic conditions. We considered the associations of each study variable with antibiotic use in a logistic regression model, stratifying by age group and adjusting for confounders.ResultsAmong 69,936 recipients with URI, 35,786 (51.2%) received an antibiotic. In all age groups, acute sinusitis, chronic sinusitis, otitis, URI type and season were associated with antibiotic use. Except for the oldest group, physician specialty and streptococcal pharyngitis were associated with antibiotic use. History of chronic conditions was not associated with antibiotic use in any age group. In all age groups, concurrent acute illnesses and history of chronic conditions had only had fair to poor ability to distinguish patients who received an antibiotic from patients who did not.ConclusionAntibiotic prevalence for URIs was high, indicating that potentially inappropriate antibiotic utilization is occurring. Our data suggest that demographic and clinical factors are associated with antibiotic use, but additional reasons remain unexplained. Insight regarding reasons for antibiotic prescribing is needed to develop interventions to address the growing problem of antibiotic resistance.
Highlights
IntroductionOur objectives were to describe patterns of upper respiratory infections (URIs) treatment and to identify patient and provider factors associated with antibiotic use for URIs. Upper respiratory tract infections (URIs) are one of the most frequent reasons patients see their physicians
Since some comorbid conditions and comorbid acute illnesses may justify the use of antibiotics for upper respiratory infections (URIs) episodes, we were interested in the predictive power of comorbid chronic conditions and comorbid acute illnesses for antibiotic use in URIs
The study variables of interest were (1) presence of concurrent acute illnesses; and (2) history of comorbid chronic conditions that might impact a physician's decision to prescribe an antibiotic
Summary
Our objectives were to describe patterns of URI treatment and to identify patient and provider factors associated with antibiotic use for URIs. Upper respiratory tract infections (URIs) are one of the most frequent reasons patients see their physicians. Inappropriate use of antibiotics leads to an unnecessarily high incidence of adverse drug reactions and additional costs with few benefits Despite this knowledge, physicians continue to prescribe antibiotics in more than 45% of URI episodes [8,9,10]. The objectives of this study were to describe patterns of upper respiratory tract infection treatment and to identify patient factors and provider specialties associated with antibiotic use. Since some comorbid conditions and comorbid acute illnesses may justify the use of antibiotics for URI episodes, we were interested in the predictive power of comorbid chronic conditions and comorbid acute illnesses for antibiotic use in URIs
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