In the Journals

Inappropriate antibiotic use still prevalent for adults in ED

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January 15, 2014

Despite significant progress in the reduction of antibiotic use for acute respiratory tract infections among children, many adults are still receiving inappropriate antibiotics for these infections when they visit the ED, according to researchers from the University of Alabama at Birmingham.

“[Acute respiratory tract infection] visits and inappropriate antibiotic use for [acute respiratory tract infections] remain important problems in the ED, particularly among adult patients,” the researchers wrote in Antimicrobial Agents and Chemotherapy. “Interventions to reduce inappropriate use of antibiotics which have historically targeted outpatient or inpatient settings must be expanded to the ED setting.”

The researchers used data from the National Hospital Ambulatory Medical Care Survey. They identified patients who presented to the ED for acute respiratory tract infection (ARTI) and classified the infections as antibiotic-appropriate (otitis media, sinusitis, pharyngitis, tonsillitis and non-viral pneumonia) or antibiotic-inappropriate (nasopharyngitis, unspecified upper respiratory infection, bronchitis or bronchiolitis, viral pneumonia or influenza).

There were 126 million ED visits from 2001 to 2010 with a diagnosis of ARTI, and ARTIs accounted for 12.2% of all ED visits. The most common infections were unspecified upper respiratory infection, otitis media and bronchitis or bronchiolitis. There was an increase in the rate of influenza during the study period, but the overall rate of ARTIs decreased.

During the study period, ARTI antibiotic use decreased from 621 to 577 per 1,000 ED visits. The rate of antibiotic utilization for antibiotic-appropriate ARTI remained stable, but the utilization declined for antibiotic-inappropriate ARTI. Antibiotic utilization was lowest among patients younger than 5 years, and there was a significant decrease in the use of antibiotics for antibiotic-inappropriate ARTI in this age group. There also was a significant decrease in use of antibiotics for antibiotic-inappropriate ARTI among patients aged 5 to 19 years.

The highest rate of antibiotic use was among patients aged at least 65 years. Among those aged 20 to 64 years, there was an increase in antibiotic use for those with antibiotic-appropriate ARTI, and there was no such increase for patients older than 65 years. Among adults aged 20 to 64 years, antibiotic use for antibiotic-inappropriate ARTI remained stable, and among adults older than 65 years, there was a nonsignificant increase.

“The current study confirms that EDs provide care to an increasingly large number of patients with ARTIs,” the researchers wrote. “The observed lack of change in antibiotic utilization for adult ARTI patients, especially those ARTIs where antibiotics are not indicated, is concerning. This may indicate that efforts to curtail inappropriate antibiotic use have not been effective; or, have not yet been implemented for this subset of patients.”

Disclosure: The researchers report no relevant financial disclosures.

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