To treat or not to treat: The role of antibiotics in the management of community-acquired respiratory tract infections in an ambulatory setting.

摘要

Background. Inappropriate antibiotic use for the management of community-acquired respiratory tract infections (RTIs) continues to be of great concern due to increasing bacterial resistance, the potential risk of adverse events, and the unnecessary wasting of economic resources. Although publications have suggested a decline in unnecessary antibiotic use for the treatment of RTIs since the early 1990s, antimicrobial treatment post 2000 in the outpatient setting is not well understood.;Objective. The purpose of our research was to determine the antibiotic prescribing trends since 1995 in adults with a diagnosis of bronchitis, CAP or sinusitis. We also evaluated the prevalence of antibiotic prescribing, the most commonly used antibiotic classes, and what particular patient and physician characteristics were predictive of antibiotic use.;Methods. Our research utilized a United States government database called the National Ambulatory Medical Care Survey (NAMCS), a cross-sectional national probability sample, which focuses on outpatient physician visits. Adults (≥ 18 years) with the diagnosis of bronchitis, CAP or sinusitis were included in study one and study two. Study three included all age groups and broadened our RTIs to also include nasopharyngitis, pharyngits, upper respiratory tract infections (URTI), influenza, and otitis media.;Results. Over the ten-year study, there was a slight decline in antibiotic use for the management of RTIs followed by a plateau period and a rebound effect. Antibiotics continued to be inappropriately used for predominantly viral infections, in particular, the fluoroquinolone class. The patient characteristics that were predictive of antibiotic use were tobacco counseling and self-paying for an office visit. The physician characteristics identified, percent revenue from private insurance and the presence of an on-site laboratory, were associated with rates of antibiotic prescribing in the management of predominantly viral RTIs.;Summary. Antibiotics continue to be inappropriately prescribed in an ambulatory setting for the treatment of patients with a diagnosis of a RTI. With a better understanding of recent trends in antibiotic utilization and the predictors of antibiotic prescribing, both from a patient and physician level, we will be better able to focus educational efforts on improving patient care through improving both the quality and quantity of antibiotic use.