A recent report revealed that in ambulatory care or during outpatient visits, approximately 40% of all antibiotics prescribed for acute respiratory tract infections (RTIs) are not appropriate for these conditions. In a recent analysis it was observed that antibiotics were prescribed for acute bronchitis (73%) and for pharyngitis (60%), thus contributing to excessive antimicrobial usage. This leads to an unnecessary increase in healthcare costs and favors the emergence, persistence, and transmission of antibiotic-resistant bacteria. Therefore, it is an urgent public health priority to improve physicians’ antibiotic prescribing.
A new study entitled, “Antibiotics for Respiratory Tract Infections: A Comparison of Prescribing in an Outpatient Setting” was published in Infection Control & Hospital Epidemiology by Dr. Tamar F. Barlam from the Section of Infectious Diseases in Department of Medicine at Boston University School of Medicine. This study aimed to examine the patient, healthcare provider, and other factors associated with the inappropriate prescribing of antibiotics for RTIs in ambulatory practices to determine where and how management efforts could be more productive.
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The researchers performed a retrospective analysis of patients older than 18 years at Boston Medical Center’s (BMC) general internal medicine and in family medicine practices between 2008 and 2010. In this study, the researchers found that prescription of an antibiotic for acute respiratory tract infections and acute bronchitis remained inappropriate in more than 40% and 70% of cases at BMC, respectively. There were also disparities in antibiotic prescriptions concerning race/ethnicity and gender, with women being prescribed more often than men, and black patients being less likely to be overprescribed antibiotics than white patients, which seemed to suggest discrimination and a potential focus for another study.
The most important factor concerning the clinician and overprescription was medical specialty. This issue could be improved by examining the curricula of the medical school and subsequently implementing strategies to improve prescribing practices. Finally, interventions meant to improve antibiotic prescriptions should be directed at clinicians that reflect higher rates of prescriptions within his/her practice, and the more conservative prescribers should be considered model physician leaders within a practice.
In other news on respiratory health, according to a recent study entitled, “Adiposity and influenza associated respiratory mortality: a cohort study,“ from The University of Hong Kong, obesity worsens the effect of seasonal influenza on respiratory mortality. Data from the study recently published in the journal Clinical Infectious Diseases revealed that older, obese people should be given priority in influenza vaccination.