February 06, 2015
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Physicians frequently prescribe unnecessary antibiotics for RTIs

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Up to 45% of physicians inappropriately prescribed antibiotics to outpatients with respiratory tract infections, according to study results published in Infection Control and Hospital Epidemiology.

“We haven’t made much progress in improving the unnecessary use of antibiotics for RTIs,” Tamar F. Barlam, MD, director of the antimicrobial stewardship program at Boston Medical Center and associate professor of medicine at Boston University School of Medicine, told Infectious Disease News. “Our study suggests that we can target our efforts more effectively by intervening early in training and enlisting physician leaders who are getting it right to serve as champions for better prescribing.”

Barlam and colleagues conducted a retrospective analysis of outpatient visits to general internal medicine and family medicine ambulatory practices at Boston Medical Center for acute respiratory tract infections (RTIs) from 2008 to 2010. There were 4,942 documented visits for RTIs.

Tamar F. Barlam

Bronchitis was associated with the most inappropriate prescribing, with 71% of patients receiving antibiotics, followed by acute pharyngitis (50%) and nonspecific upper RTI (28%). These rates are consistent with previous data.

In addition, women were more frequently prescribed antibiotics than men; blacks were less likely to be overprescribed antibiotics than whites.

“It is concerning that there may be a different approach to patients depending on race or gender, which may suggest inequities in care,” Barlam said.

The researchers wrote that medical specialty — namely family medicine — was the only significant physician factor that predicted inappropriate prescribing (P = .002). Physicians who overprescribed also tended to have more patients with chronic lung disease (P < .001).

Finally, general internal medicine practices with a high prescriber were 30% more likely to have another high prescriber at the same location, and those with a low-prescribing physician were three times more likely to have a second low prescriber. This suggested that providing feedback about antibiotic prescribing to the individual physician can have an impact on the entire practice.

“Therefore, interventions could focus on bronchitis and pharyngitis RTI visits seen by the highest quartile prescribers or could concentrate on developing physician leaders within the lowest quartile,” the researchers wrote. “These strategies could lead to a better use of resources for antibiotic stewardship interventions than targeting an entire practice.” – by John Schoen

Disclosure: The researchers report no relevant financial disclosures.