Trends in emergency department antibiotic prescribing for acute respiratory tract infections

BACKGROUND: Injudicious use of antibiotics is associated with the reported rise in antibiotic-resistant bacteria. With an estimated 26 million antibiotics being prescribed annually in the emergency department (ED), the ED represents an important setting for targeting interventions. OBJECTIVE: To provide national estimates of potentially inappropriate antibiotic prescribing during ED visits for acute respiratory tract infections (ARTIs) and examine associations between patient, provider, visit characteristics, and antibiotic prescribing patterns. METHODS: A cross-sectional study was conducted of ED visits for ARTIs, identified from pooled 1995-2000 National Hospital Ambulatory Medical Care Survey data. National estimates, descriptive statistics, and multivariate analyses were used to assess antibiotic prescribing patterns. RESULTS: An estimated 51.3 million ED visits for ARTIs occurred during the study period, 62% of which had an antibiotic prescribed. For a narrowly defined subset of ARTIs, where antibiotic therapy is nearly always inappropriate (eg, nasopharyngitis, ARTI of multiple or unspecified sites, acute bronchitis), the percentage decreased over the 6-year period from 57% to 44% (p < 0.01). For children ED visits, however, the downward trend occurred almost exclusively in urban ElDs. Compared with visits in which a resident or intern physician was involved, the odds of antibiotic prescribing for child ED ARTI visits were 2.2 times higher for staff physicians (95% Cl 1.3 to 3.6) and 1.8 times higher for nonphysicians with prescribing privileges (95% Cl 1.3 to 2.4). CONCLUSIONS: ED antibiotic prescribing for ARTIs has decreased from 1995 to 2000, but still is occurring in well over half of ED visits for ARTI. Further research assessing knowledge and attitudes of patients and providers about antibiotic prescribing is needed.