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Antibiotic prescribing for nonbacterial acute upper respiratory infections in elderly persons

Silverman M, Povitz M, Sontrop JM, Li L, Richard L, Cejic S, Shariff SZ. Ann Intern Med. 2017; 166(11):765-74. Epub 2017 May 9.


Importance — Reducing inappropriate antibiotic prescribing for acute upper-respiratory infections (AURI) requires a better understanding of the factors associated with this practice.

Objective — To determine the prevalence of antibiotic prescribing for non-bacterial AURIs and whether prescribing rates varied by physician characteristics.

Setting — Primary-care physician practices in Ontario, Canada (January–December 2012).

Design — Retrospective analysis of linked administrative healthcare data.

Participants — Patients (age >66) with non-bacterial AURIs. We excluded patients with cancer or immunosuppressive conditions, and residents of long-term care homes.

Outcome — Antibiotic prescriptions for physician-diagnosed AURIs. We used a multivariable logistic regression model with generalized estimating equations to examine whether prescribing rates varied by physician characteristics, accounting for clustering of patients among physicians and adjusting for patient-level covariates.

Results — Our cohort included 8 990 primary-care physicians and 185 014 patients who presented with a non-bacterial AURI, including the common cold (53.4%), acute bronchitis (31.3%), acute sinusitis (13.6%), or acute laryngitis (1.6%). Forty-six percent of patients received an antibiotic prescription; the majority of prescriptions were for broad-spectrum agents (69.9%; 95% CI: 69.6–70.2%). Patients were more likely to receive prescriptions from mid- and late-career physicians vs. early-career physicians (rate difference: 5.1%; 95% CI: 3.9–6.4% and 4.6%; 95% CI: 3.3%–5.8%, respectively), from physicians trained outside of Canada and the U.S. (3.6%; 95% CI: 2.5–4.6%), and from physicians who saw 25–44 patients/day or >45 patients/day vs. <25 patients/day (3.1%; 95% CI: 2.1–4.0% and 4.1%; 95% CI: 2.7–5.5%, respectively).

Limitations — Physician rationale for prescribing was unknown.

Conclusions and Relevance — In this low-risk elderly cohort, 46% of patients with a non-bacterial AURI were prescribed antibiotics. Patients were more likely to receive prescriptions from mid-to-late-career physicians with high patient volumes, and from physicians who were trained outside of Canada or the U.S.

Keywords: Clinical guidelines Drug prescribing behaviour Drugs (antibiotics)

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