Use of Antibiotics for Adult Upper RespiratoryInfections in Outpatient Settings: A NationalAmbulatory Network Study

摘要

BACKGROUND AND OBJECTIVES: Studies have suggested that antibiotics are often inappropriately usedin the treatment of acute upper respiratory tract infections (URIs). This study examined antibioticuse for adult URIs in a large national network of offices that use electronic health records (EHRs).METHODS: Using the Medical Quality Improvement Consortium (MQIC) database, URI episodes wereidentified for patients ages 18 to 65 years from January 1, 1998, to March 31, 2003. The percentageof episodes for which antibiotics were prescribed and the proportion of antibiotics that were broadspectrum were calculated. RESULTS: Of the 52,135 URI episodes identified, 65% received antibiotics.Antibiotics were prescribed for 78% of acute bronchitis episodes, 65% of acute pharyngitis episodes,81% of acute sinusitis episodes, and 33% of nonspecific URI episodes. The proportion of antibioticsthat were broad spectrum was 56% for all URI episodes, 68% for acute bronchitis, 55% for acute sinusitisand nonspecific URI, and 40% for pharyngitis. CONCLUSIONS: This study demonstrates overuseof antibiotics for adult URIs in a large national ambulatory care network, with particular overuse ofbroad-spectrum antibiotics. The study also illustrates the enormous potential of EHR data for conductingpractice-based research across large national office networks.