What Factors Influence Prescribing of Unnecessary Antibiotics for Respiratory Infections?

Almost half of elderly patients who visited a primary care physician with a nonbacterial acute upper respiratory tract infection (AURI) were prescribed antibiotics, according to a new analysis.

The retrospective analysis examined prescribing patterns using linked administrative health care data from January 2012 through December 2012 in a cohort of 8990 primary care physicians practicing in Ontario, Canada and 185,014 patients aged 66 years and older diagnosed with AURIs. Regression models were used to examine whether prescribing rates varied by physician characteristics.
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Of the 185,014 patients included in the analysis, 53.4% presented with the common cold, 31.3% presented with acute bronchitis, 13.6% presented with acute sinusitis, and 1.6% presented with acute laryngitis.

Overall, 46% of patients received an antibiotic prescription, 69.9% of which were broad-spectrum agents.

Physicians in the middle or late stage of their career were more likely to prescribe antibiotics compared with physicians at the beginning of their career. Moreover, physicians who saw 25 to 44 patients a day or more than 45 patients a day were more likely to prescribe antibiotics for nonbacterial AURIs compared with those who saw fewer than 25 patients a day.

More antibiotics were prescribed for nonbacterial AURIs by physicians who were trained outside the United States and Canada.

“In this low-risk elderly cohort, 46% of patients with a nonbacterial AURI were prescribed antibiotics,” the researchers concluded. “Patients were more likely to receive prescriptions from mid- or late-career physicians with high patient volumes and from physicians who were trained outside of Canada or the United States”

—Melissa Weiss

Reference:

Silverman M, Povitz M, Sontrop JM, et al. Antibiotic prescribing for nonbacterial acute upper respiratory infections in elderly persons [published online May 9, 2017]. Ann Intern Med. doi:10.7326/M16-1131.