Antibiotic prescribing for acute respiratory tract infections in the United States outpatient setting

• Published in: BMC family practice Vol. 20; no. 1; pp. 91 - 10
• Main Authors: Shaver, Amy L, Jacobs, David M, LaMonte, Michael J, Noyes, Katia
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02-07-2019; BioMed Central; BMC
• Subjects: Acute Disease; Adolescent; Adult; African Americans; Aged; Aged, 80 and over; Ambulatory Care; Ambulatory care facilities; Anti-Bacterial Agents - therapeutic use; Antibiotics; Child; Dosage and administration; Drug therapy; European Continental Ancestry Group; Family medicine; Female; General practice; General practitioners; Humans; Infection; Logistic Models; Male; Medical economics; Medical practice; Middle Aged; Nurse Practitioners; Nurses; Nursing services; Physician Assistants; Physicians; Practice Patterns, Nurses; Practice Patterns, Physicians' - statistics & numerical data; Practice Patterns, Physicians' - trends; Respiratory tract diseases; Respiratory tract infections; Respiratory Tract Infections - drug therapy; Respiratory Tract Infections - epidemiology; United States; United States - epidemiology; Upper respiratory tract infection, outpatient; Young Adult; United States; General practice; Antibiotics; United States; Upper respiratory tract infection, outpatient
• ISSN: 1471-2296; 1471-2296
• DOI: 10.1186/s12875-019-0980-1

Acute respiratory tract infections (ARIs) are common in the outpatient setting. Although they are predominantly viral, antibiotics are often prescribed for the treatment of ARIs.
Using the U.S. Medical Expenditure Panel Survey (MEPS; 2010-2015), we estimated the national prevalence and predictors of outpatient antibiotic prescribing for ARIs by provider type. We categorized the trends of antibiotic prescriptions (overall or broad-spectrum) for ARIs by provider type (physician and advanced practice provider [APP] which includes nurse practitioner [NP], and physician assistant [PA]). The outcome variable was defined as receipt of an antibiotic prescription during a consultation with a provider for an ARI (including outpatient clinic visit or doctor's office visit).
There were 64,081,892 ARI antibiotic prescriptions written, with a decrease from 10.9 (2010) to 9.7 million (2015) during the study interval (p < 0.0001). Associations of patient- and provider-level variables with antibiotics prescription were examined using binary logistic regression. Blacks were more likely to receive antibiotics than whites (OR 1.51; 95% CI 1.25, 1.84; p < 0.001), and antibiotic prescription was more likely if the patient-provider race was concordant (OR 5.41; 95% CI 4.65, 6.29, p < 0.0001). Although the majority of patients with ARI were cared for by physicians, APPs were seeing an increasing number of ARI patients.
Antibiotic prescribing for ARIs though declining, remains high. More research is needed to better understand the drivers of ARI antibiotic prescribing and to develop targeted interventions for both patients and providers.