Inappropriate Antibiotics for ARIs: What are the leading causes?

Eliminating antibiotic treatment of viral upper respiratory tract infections (URTI) and bronchitis, improving influenza diagnosis, and reinforcing prescription guidelines for pharyngitis and sinusitis could all help to improve outpatient antibiotic stewardship, according to a recent study.

Although most acute respiratory infections (ARIs) are caused by viruses, ARIs are the condition for which antibiotics are most commonly prescribed.

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In order to characterize antibiotic prescribing among outpatients with ARI during influenza season and identify targets for the reduction of inappropriate antibiotic prescribing, researchers conducted a cohort study of patients aged 6 months or older with ARI during the 2013-2014 and 2014-2015 influenza seasons.

All participants were tested for influenza with real-time reverse transcriptase-polymerase chain reaction.

Of the 14,987 patients with ARI, 6136 were prescribed an antibiotic, of whom 2522 (41%) had diagnoses for which antibiotics were not indicated (2106 were diagnosed with URTIs or bronchitis). Among the 3306 patients who did not have pneumonia and had laboratory-confirmed influenza, 945 (29%) were prescribed an antibiotic. Among the 1248 patients with pharyngitis, 440 (35%) were prescribed antibiotics, of whom 38% had negative group a streptococcal results.

Of the 1200 patients with sinusitis who received an antibiotic, 454 (38%) had symptoms for 3 days or less prior to the outpatient visit, suggesting acute viral sinusitis not requiring antibiotics.

“Our study adds to evidence that misuse of antibiotics, characterized by antibiotic overuse and inappropriate antibiotic selection, is widespread in the treatment of outpatient ARIs,” the researchers concluded.

“Improving antibiotic prescribing for ARIs during the influenza season represents an important opportunity to improve the long-term quality of patient care.”

—Michael Potts

Reference:

Havers FP, Hicks LA, Chung JR, et al. Outpatient antibiotic prescribing for acute respiratory infections during influenza seasons. JAMA Network Open. 2018;1(2): e180243.