A new study entitled “Antibiotic Use for Viral Acute Respiratory Tract Infections Remains Common,” recently published in The American Journal of Managed Care, calls clinicians’ and patients’ attention to unintentional adverse consequences of inappropriate antibiotic prescribing for Viral Acute Respiratory Tract Infections.
Acute viral (upper) respiratory tract infections (ARTIs) are one of the most frequent reasons for a healthcare encounter in the United States, with estimates over 43 million ambulatory visits per year for cough or sore throat and many days of lost productivity. ARTI with cough as the principal symptom are normally called “acute bronchitis.” The majority of cases are caused by viruses, and in healthy adults, these infections are typically self-controlled and do not require a physician visit or a prescription medication. Treatment of a self-limited condition with antibiotics will increase the visit probability of the patient to a physician in a second episode of respiratory tract infection (RTI).
Previous studies have shown that over 60% of adults with ARTI received an antibiotic normally with progressively more broad-spectrum. Several clinical trials have shown that azithromycin, amoxicillin, and amoxicillin-clavulanate do not improve outcomes for patients with acute bronchitis, in contrast may lead to important consequences such as antibiotic resistance, with high economical impact on the US economy.
The study determined the type and number of antibiotic prescriptions filled in the 28 days following an index visit for acute respiratory tract infections (ARTIs) generally of viral origin. The research team analyzed administrative data from a regional health system, not including academic medical centers or training programs, between 2000 and 2012, in the southeastern United States with a population of 26.5% African American and 10.4% Hispanic, according to 2010 Census report. The authors did not limit the analysis by age or sex of the patient and included any visit with a primary or secondary diagnosis of an upper RTI that is normally viral in etiology and does not require antibiotic therapy based on evidence-based practice guidelines.
The main finding was that clinicians in community practice still prescribe greatly antibiotics for ARTIs caused mainly or exclusively by viruses. Prescriptions are particularly high when the clinical diagnosis is acute bronchitis, when patients are seen by a clinician in an urgent care setting, or when they are seen by a nurse practitioner or physician assistant. While the antibiotic prescriptions are very frequent in older patients with pediatricians the rates of prescribing antibiotics are the lowest. However, the use of anti-influenza drugs is highly prevalent among people with ages between 5 and 17 years old. Particularly interesting was that 8.9% of patients received a second antibiotic and 0.7% received a third during the 28 days following the index encounter.
The authors stated that the use of antibiotics were declining until 2007 but raised again in 2007, probably due to an increase in the use of macrolides, despite a lack of evidence of clinically meaningful benefit of these medicines for patients with ARTIs, and fact that azithromycin became available as a generic medication.
Finally, the authors stress the great concern over the rise of antibiotic use for the majority viral ARTIs between 2007 and 2012. Moreover, they highlight the importance of public health messaging to the community, ongoing education for physicians, and patient education by physicians, that antibiotics are not effective for acute bronchitis and other supposedly viral ARTIs.