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Study: Unnecessary Antibiotics Often Prescribed for Respiratory Infections in Outpatient Settings

Habit likely formed during medical school or residency, authors say

A new study has found that 45% of patients with respiratory-tract infections (RTIs) were inappropriately prescribed antibiotics in an outpatient practice of general internal medicine and family medicine. The study was published in the February issue of Infection Control & Hospital Epidemiology.

In the ambulatory care setting, antibiotics are often prescribed inappropriately for RTIs, according to the article. Such infections, which include bronchitis, acute pharyngitis, and upper RTI, often do not require antibiotic interventions. Excessive antimicrobial use has been linked to increased health care costs and the emergence of antibiotic-resistant bacteria.

“Physicians’ inappropriate prescribing patterns appeared to differ by medical specialty and to be established early, likely during medical school or residency,” said lead author Tamar Barlam, MD, of the Boston University School of Medicine. “Instituting aggressive interventions in training or practice at the right time and to the right physicians could improve antibiotic use and the efficacy of antibiotic stewardship in outpatient settings.”

Barlam and her colleagues conducted a retrospective analysis of outpatient visits for patients who sought care for RTIs within a general internal medicine and family medicine practice at Boston Medical Center. A total of 4,942 visits were recorded during the 2-year study period.

Bronchitis was associated with the highest amount of inappropriate antibiotic use (71% of patients received antibiotics), followed by pharyngitis (50%) and nonspecific upper RTI (28%). In addition, the researchers found that women were prescribed antibiotics more often than men, and that black patients were less likely to be overprescribed antibiotics than white patients.

“It is concerning that there may be a different approach to patients depending on race or gender, which may suggest inequities in care,” Barlam said.

The authors suggest implementing comprehensive education about antimicrobials and stewardship in medical school curricula to prevent the establishment of poor prescribing practices. Other suggestions include enlisting low prescribers as physician leaders alongside high prescribers to influence the efficient use of resources.

Source: SHEA; February 4, 2015.

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