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Antibiotic prescribing for nonbacterial acute upper respiratory infections in elderly persons


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.



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.

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