Even with the implementation of antibiotic stewardship interventions, only modest improvements have been observed in antibiotic prescribing practices. A retrospective analysis was conducted to examine patient and provider factors associated with inappropriate antibiotic prescribing for acute respiratory tract infection (RTI) visits at hospital-associated ambulatory practices in an inner-city academic medical center from 2008–2010. Data on RTI outpatient visits for patients ages ≥18 and prescribing practices was extracted from electronic medical records, including both patient and physician variables. Antibiotic prescriptions were labeled as inappropriate for viral RTI, viral bronchitis, viral pneumonia, influenza, or pleurisy.
Of the 4,942 patient visits conducted by an attending staff physician with at least 10 RTI visits (79 physicians), acute upper respiratory infection (URI) of unspecified site and other nonspecific URIs were the most commonly diagnosed RTIs. Acute bronchitis was associated with the most inappropriate antibiotic use; of visits with a bronchitis diagnosis, 67% included an antibiotic prescription after excluding patients with chronic lung disease or asthma. Physicians prescribed antibiotics inappropriately in 45% of all RTI visits. Family medicine practitioners were more likely to prescribe inappropriately than were general internists and female patients were prescribed antibiotics more often than men. African-American patients were also less likely to be overprescribed antibiotics compared to Caucasian patients.
Particularly with cases of acute bronchitis, inappropriate prescribing of antibiotics was significant in this study. Because medical specialty was the most significant physician factor associated with inappropriate prescribing, medical school curricula may be an appropriate place for interventions to improve prescribing at earlier stages in training.