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Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments.
Antimicrob Agents Chemother. 2014; 58(3):1451-7.AA

Abstract

Inappropriate use of antibiotics for acute respiratory tract infections (ARTIs) has decreased in many outpatient settings. For patients presenting to U.S. emergency departments (EDs) with ARTIs, antibiotic utilization patterns are unclear. We conducted a retrospective cohort study of ED patients from 2001 to 2010 using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). We identified patients presenting to U.S. EDs with ARTIs and calculated rates of antibiotic utilization. Diagnoses were classified as antibiotic appropriate (otitis media, sinusitis, pharyngitis, tonsillitis, and nonviral pneumonia) or antibiotic inappropriate (nasopharyngitis, unspecified upper respiratory tract infection, bronchitis or bronchiolitis, viral pneumonia, and influenza).There were 126 million ED visits with a diagnosis of ARTI, and antibiotics were prescribed in 61%. Between 2001 and 2010, antibiotic utilization decreased for patients aged<5 presenting with antibiotic-inappropriate ARTI (rate ratio [RR], 0.94; confidence interval [CI], 0.88 to 1.00). Utilization also decreased significantly for antibiotic-inappropriate ARTI patients aged 5 to 19 years (RR, 0.89; CI, 0.85 to 0.94). Utilization remained stable for antibiotic-inappropriate ARTI among adult patients aged 20 to 64 years (RR, 0.99; CI, 0.97 to 1.01). Among adults, rates of quinolone use for ARTI increased significantly from 83 per 1,000 visits in 2001 to 2002 to 105 per 1,000 in 2009 to 2010 (RR, 1.08; CI, 1.03 to 1.14). Although significant progress has been made toward reduction of antibiotic utilization for pediatric patients with ARTI, the proportion of adult ARTI patients receiving antibiotics in U.S. EDs is inappropriately high. Institution of measures to reduce inappropriate antibiotic use in the ED setting is warranted.

Authors+Show Affiliations

Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

24342652

Citation

Donnelly, John P., et al. "Antibiotic Utilization for Acute Respiratory Tract Infections in U.S. Emergency Departments." Antimicrobial Agents and Chemotherapy, vol. 58, no. 3, 2014, pp. 1451-7.
Donnelly JP, Baddley JW, Wang HE. Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments. Antimicrob Agents Chemother. 2014;58(3):1451-7.
Donnelly, J. P., Baddley, J. W., & Wang, H. E. (2014). Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments. Antimicrobial Agents and Chemotherapy, 58(3), 1451-7. https://doi.org/10.1128/AAC.02039-13
Donnelly JP, Baddley JW, Wang HE. Antibiotic Utilization for Acute Respiratory Tract Infections in U.S. Emergency Departments. Antimicrob Agents Chemother. 2014;58(3):1451-7. PubMed PMID: 24342652.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments. AU - Donnelly,John P, AU - Baddley,John W, AU - Wang,Henry E, Y1 - 2013/12/16/ PY - 2013/12/18/entrez PY - 2013/12/18/pubmed PY - 2014/10/29/medline SP - 1451 EP - 7 JF - Antimicrobial agents and chemotherapy JO - Antimicrob Agents Chemother VL - 58 IS - 3 N2 - Inappropriate use of antibiotics for acute respiratory tract infections (ARTIs) has decreased in many outpatient settings. For patients presenting to U.S. emergency departments (EDs) with ARTIs, antibiotic utilization patterns are unclear. We conducted a retrospective cohort study of ED patients from 2001 to 2010 using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). We identified patients presenting to U.S. EDs with ARTIs and calculated rates of antibiotic utilization. Diagnoses were classified as antibiotic appropriate (otitis media, sinusitis, pharyngitis, tonsillitis, and nonviral pneumonia) or antibiotic inappropriate (nasopharyngitis, unspecified upper respiratory tract infection, bronchitis or bronchiolitis, viral pneumonia, and influenza).There were 126 million ED visits with a diagnosis of ARTI, and antibiotics were prescribed in 61%. Between 2001 and 2010, antibiotic utilization decreased for patients aged<5 presenting with antibiotic-inappropriate ARTI (rate ratio [RR], 0.94; confidence interval [CI], 0.88 to 1.00). Utilization also decreased significantly for antibiotic-inappropriate ARTI patients aged 5 to 19 years (RR, 0.89; CI, 0.85 to 0.94). Utilization remained stable for antibiotic-inappropriate ARTI among adult patients aged 20 to 64 years (RR, 0.99; CI, 0.97 to 1.01). Among adults, rates of quinolone use for ARTI increased significantly from 83 per 1,000 visits in 2001 to 2002 to 105 per 1,000 in 2009 to 2010 (RR, 1.08; CI, 1.03 to 1.14). Although significant progress has been made toward reduction of antibiotic utilization for pediatric patients with ARTI, the proportion of adult ARTI patients receiving antibiotics in U.S. EDs is inappropriately high. Institution of measures to reduce inappropriate antibiotic use in the ED setting is warranted. SN - 1098-6596 UR - https://www.unboundmedicine.com/medline/citation/24342652/Antibiotic_utilization_for_acute_respiratory_tract_infections_in_U_S__emergency_departments_ L2 - http://aac.asm.org/cgi/pmidlookup?view=long&amp;pmid=24342652 DB - PRIME DP - Unbound Medicine ER -