Steven Fox
January 15, 2014
Full Story (may require free registration): http://www.medscape.com/viewarticle/819281
Clinicians in emergency rooms appear to be getting the message that antibiotics need to be used judiciously in pediatric patients. However, that same message, as it pertains to adults, may need reinforcement.
“Inappropriate use of antibiotics for acute respiratory tract infections (ARTIs) has decreased in many outpatient settings,” write John W. Baddley, MD, MSPH, from the University of Alabama, Birmingham, and coauthors. However, “[f]or patients presenting to US [EDs] with ARTIs, antibiotic utilization patterns are unclear.”
Therefore, the investigators designed a retrospective cohort study using data from the National Hospital Ambulatory Medical Care Survey. The data included information on antibiotic use in 126 million people who presented at EDs nationwide for treatment of ARTIs during the period from 2001 to 2010. The study was published online December 16 in Antimicrobial Agents and Chemotherapy.
On the basis of established guidelines for proper antibiotic use, the researchers classified antibiotic use as either appropriate or inappropriate. Appropriate usage included antibiotic treatment for otitis media, sinusitis, pharyngitis, tonsillitis, or nonviral pneumonia. Inappropriate usage included prescribing antibiotics for nasopharyngitis, unspecified upper respiratory tract infections, bronchitis or bronchiolitis, viral pneumonia, or influenza.
All told, 61% of patients presenting with ARTIs were prescribed antibiotics.
“While we observed a decrease in ARTI antibiotic use among patients aged ≤19 years, we observed no decrease in ARTI antibiotic utilization among adult patients, even for those ARTIs where antibiotics are not routinely indicated,” the authors write.
Specifically, inappropriate use of the drugs declined during the study period for patients younger than 5 years (rate ratio [RR], 0.94; 95% confidence interval [CI], 0.88 – 1.00). In addition, their use decreased significantly in patients aged 5 to 19 years (RR, 0.89; 95% CI, 0.85 – 0.94).
However, levels of inappropriate use remained unchanged for adults aged 20 to 64 years (RR, 0.99; 95% CI, 0.97 – 1.01).
The authors also emphasize that the use of quinolones is increasing. That class of antibiotics was the medication of choice in about 83 per 1000 ARTI visits during 2001-2002 compared with about 105 per 1000 visits during the final 2 years of the study period.
“These results highlight the urgent need to reduce inappropriate use of ARTIs in the ED setting and provide better treatment for those who could benefit from antibiotic therapy,” the researchers conclude.
Antimicrobial Agents Chemother. Published online December 16, 2013. Full text