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Antibiotic treatment of acute respiratory infections in acute care settings.
Acad Emerg Med 2006; 13(3):288-94AE

Abstract

OBJECTIVES

To examine the patterns of antibiotic use for acute respiratory tract infections (ARIs) in acute care settings.

METHODS

Chart reviews were performed retrospectively on a random sample of adult ARI visits to seven Veterans Affairs (VA) and seven non-VA emergency departments (EDs) for the period of November 2003 to February 2004. Visits were limited to those discharged to home and those with primary diagnoses of antibiotic-responsive (pneumonia, acute exacerbation of chronic bronchitis, pharyngitis, sinusitis) and antibiotic-nonresponsive conditions (acute bronchitis, nonspecific upper respiratory tract infection [URI]). Results are expressed as adjusted odds ratios with 95% confidence intervals.

RESULTS

Of 2,270 ARI visits, 62% were for antibiotic-nonresponsive diagnoses. Seventy-two percent of acute bronchitis and 38% of URI visits were treated with antibiotics (p < 0.001). Stratified analyses show that antibiotic prescription rates were similar among attending-only and housestaff-associated visits for antibiotic-responsive diagnoses (p = 0.11), and acute bronchitis (76% vs. 59%; p = 0.31). However, the antibiotic prescription rate for URIs was greater for attending-only visits compared with housestaff-associated visits (48% vs. 15%; p = 0.01). Antibiotic prescription rates for total ARIs varied between sites, ranging from 42% to 89%. Patient age, gender, race and ethnicity, smoking status, comorbidities, and clinical setting (VA vs. non-VA) were not independently associated with antibiotic prescribing.

CONCLUSIONS

Acute care settings are important targets for reducing inappropriate antibiotic prescribing. The mechanisms accounting for lower antibiotic prescription rates observed with housestaff-associated visits merit further study.

Authors+Show Affiliations

Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA 94118, USA. ralphg@medicine.ucsf.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16514122

Citation

Gonzales, Ralph, et al. "Antibiotic Treatment of Acute Respiratory Infections in Acute Care Settings." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 13, no. 3, 2006, pp. 288-94.
Gonzales R, Camargo CA, MacKenzie T, et al. Antibiotic treatment of acute respiratory infections in acute care settings. Acad Emerg Med. 2006;13(3):288-94.
Gonzales, R., Camargo, C. A., MacKenzie, T., Kersey, A. S., Maselli, J., Levin, S. K., ... Metlay, J. P. (2006). Antibiotic treatment of acute respiratory infections in acute care settings. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 13(3), pp. 288-94.
Gonzales R, et al. Antibiotic Treatment of Acute Respiratory Infections in Acute Care Settings. Acad Emerg Med. 2006;13(3):288-94. PubMed PMID: 16514122.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antibiotic treatment of acute respiratory infections in acute care settings. AU - Gonzales,Ralph, AU - Camargo,Carlos A,Jr AU - MacKenzie,Thomas, AU - Kersey,Ayanna S, AU - Maselli,Judith, AU - Levin,Sara K, AU - McCulloch,Charles E, AU - Metlay,Joshua P, AU - ,, PY - 2006/3/4/pubmed PY - 2006/4/28/medline PY - 2006/3/4/entrez SP - 288 EP - 94 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 13 IS - 3 N2 - OBJECTIVES: To examine the patterns of antibiotic use for acute respiratory tract infections (ARIs) in acute care settings. METHODS: Chart reviews were performed retrospectively on a random sample of adult ARI visits to seven Veterans Affairs (VA) and seven non-VA emergency departments (EDs) for the period of November 2003 to February 2004. Visits were limited to those discharged to home and those with primary diagnoses of antibiotic-responsive (pneumonia, acute exacerbation of chronic bronchitis, pharyngitis, sinusitis) and antibiotic-nonresponsive conditions (acute bronchitis, nonspecific upper respiratory tract infection [URI]). Results are expressed as adjusted odds ratios with 95% confidence intervals. RESULTS: Of 2,270 ARI visits, 62% were for antibiotic-nonresponsive diagnoses. Seventy-two percent of acute bronchitis and 38% of URI visits were treated with antibiotics (p < 0.001). Stratified analyses show that antibiotic prescription rates were similar among attending-only and housestaff-associated visits for antibiotic-responsive diagnoses (p = 0.11), and acute bronchitis (76% vs. 59%; p = 0.31). However, the antibiotic prescription rate for URIs was greater for attending-only visits compared with housestaff-associated visits (48% vs. 15%; p = 0.01). Antibiotic prescription rates for total ARIs varied between sites, ranging from 42% to 89%. Patient age, gender, race and ethnicity, smoking status, comorbidities, and clinical setting (VA vs. non-VA) were not independently associated with antibiotic prescribing. CONCLUSIONS: Acute care settings are important targets for reducing inappropriate antibiotic prescribing. The mechanisms accounting for lower antibiotic prescription rates observed with housestaff-associated visits merit further study. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/16514122/Antibiotic_treatment_of_acute_respiratory_infections_in_acute_care_settings_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=1069-6563&amp;date=2006&amp;volume=13&amp;issue=3&amp;spage=288 DB - PRIME DP - Unbound Medicine ER -