Antibiotics are ineffective for treating infections caused by viruses. Inappropriate antibiotic use has been shown to be a contributing factor to antibiotic resistance. Studies indicate that the inappropriate use of antibiotics for acute respiratory tract infections (RTIs) has decreased in many outpatient settings, largely as a result of education and antibiotic stewardship programs. However, little is known about antibiotic utilization patterns in the United States for patients presenting to EDs with acute RTIs.

Examining Trends

To investigate this issue, John W. Baddley, MD, MSPH, teamed up with colleagues in the ED to examine data from the National Hospital Ambulatory Medical Care Survey from 2001 to 2010. In a study published in Antimicrobial Agents and Chemotherapy, they identified patients presenting to EDs with acute RTIs and calculated rates of antibiotic utilization. Diagnoses were classified as antibiotic-appropriate for cases of otitis media, sinusitis, pharyngitis, tonsillitis, and non-viral pneumonia. Diagnoses were antibiotic-inappropriate for cases of nasopharyngitis, unspecified upper RTIs, bronchitis or bronchiolitis, viral pneumonia, and influenza.

 

ED-Antibiotic-Use-Callout

 

According to the results, acute RTIs accounted for 126 million visits to U.S. EDs during the study period examined, or about 12% of all ambulatory care visits nationally. “Antibiotics were prescribed in 61% of acute RTIs even though many of these infections were viral and did not require treatment with these medications,” says Dr. Baddley. “Oftentimes, antibiotics were inappropriately prescribed for acute RTIs that were likely caused by a virus.”

Between 2001 and 2010, inappropriate antibiotic use decreased in pediatric settings but not in adult settings. “Considering the efforts to promote antibiotic stewardship, we expected to see a decrease in ED antibiotic use for acute RTIs across all patient populations,” Dr. Baddley says. “Our findings, however, did not extend to adult patients.”

Significant Implications

Dr. Baddley suggests that measures be taken to reduce the inappropriate use of antibiotics in the ED setting. “Antibiotic stewardship programs should be implemented with involvement from EDs,” he says. “Emergency rooms aren’t just used for emergencies; many patients use them for basic primary care.” More resources may be necessary to curb inappropriate antibiotic use or to implement antibiotic stewardship programs beyond the outpatient setting.

Several factors may be contributing to the lack of reduction in antibiotic use for acute RTIs. For example, ED physicians may sometimes have difficulty making definitive diagnoses. Another factor is that patients often expect to receive antibiotics and will pressure ED physicians to provide these drugs even though they are inappropriate. “We need to better educate ED personnel and patients about the risks of inappropriate antibiotic use,” says Dr. Baddley. “Antibiotic stewardship programs should also extend to the ED setting.”

References

Donnelly JP, Baddley JW, Wang HE. Antibiotic utilization for acute respiratory tract infections in United States emergency departments. Antimicrob Agents Chemother. 2014;58:1451-1457. Available at: http://aac.asm.org/content/58/3/1451.abstract.

Thorpe JM, Smith SR, Trygstad TK. Trends in emergency department antibiotic prescribing for acute respiratory tract infections. Ann Pharmacother. 2004;38:928-935.

Grijalva CG, Nuorti JP, Griffin MR. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA. 2009; 302:758-766.

Stone S, Gonzales R, Maselli J, Lowenstein SR. Antibiotic prescribing for patients with colds, upper respiratory tract infections, and bronchitis: a national study of hospital-based emergency departments. Ann Emerg Med. 2000;36:320-327.