• Acad Emerg Med · Mar 2006

    Antibiotic treatment of acute respiratory infections in acute care settings.

    • Ralph Gonzales, Carlos A Camargo, Thomas MacKenzie, Ayanna S Kersey, Judith Maselli, Sara K Levin, Charles E McCulloch, Joshua P Metlay, and IMPAACT Trial Investigators.
    • Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA 94118, USA. ralphg@medicine.ucsf.edu
    • Acad Emerg Med. 2006 Mar 1; 13 (3): 288-94.

    ObjectivesTo examine the patterns of antibiotic use for acute respiratory tract infections (ARIs) in acute care settings.MethodsChart 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.ResultsOf 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.ConclusionsAcute 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.

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