Evaluation of Antibiotic Prescribing for Acute Respiratory Tract Infections in the Ambulatory Care Setting. (4th October 2017)

• Record Type: Journal Article
• Authors: Molino, Suzanne T; Stranges, Paul M; Bleasdale, Susan C; Shapiro, Nancy L; Suda, Katie J; Gross, Alan E
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S578
• Page End: S578
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.1510
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Acute respiratory tract infections (RTI), such as sinusitis, pharyngitis, and bronchitis, generate a significant number of outpatient prescriptions and are targets for antibiotic stewardship efforts because they are typically of viral origin and self-limited. The objective of this study is to identify current antibiotic prescribing practices for RTI in a large, outpatient, ambulatory care setting. Methods: This retrospective, single-center, cohort study was designed to identify the proportion of antibiotics prescribed for the treatment of RTI, during ambulatory care visits for patients >18 years in an urban, public, academic medical center from 11/1/2014 to 7/31/2016. ICD-9/-10 codes were used to identify cases. The primary endpoint was the proportion of antibiotics prescribed for the treatment of acute sinusitis, pharyngitis, and bronchitis. Secondary endpoints included: antibiotic agent classes and Clostridium difficile infection (CDI) within 90 days post-antibiotic prescription. Additional data regarding patient demographics, medical history, allergies, antibiotic dosing and course, and prescriber information were collected. Results: For acute bronchitis, 142/345 (41%) encounters were associated with an antibiotic, mostly azithromycin (84.5%). For acute sinusitis, 511/988 (52%) encounters were associated with an antibiotic, mostly amoxicillin-clavulanate (52%). For acute pharyngitis, 271/1038 (26%) encounters were associated with an antibiotic, mostly penicillin VK (45%). Seasonality in prescribing rates were observed. There were three cases of CDI within 90 days of an antibiotic prescription, one following azithromycin use for bronchitis and two following amoxicillin-clavulanate use for sinusitis. Conclusion: A significant number of visits for RTI could benefit from antibiotic stewardship interventions. Antibiotic prescribing for acute bronchitis is never clinically appropriate. Furthermore, prescribing rates for acute sinusitis and pharyngitis were much higher than the expected appropriate rate based on national epidemiologic data. These local prescribing data can be used to direct patient and provider education and to provide a baseline to measure the effect of stewardship interventions. Disclosures: All authors: No reported disclosures.