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Study Identifies Factors Associated with Antibiotic Prescribing for Likely Non-Bacterial Respiratory Infections


Although antibiotic prescribing for adults with acute respiratory infections in the outpatient setting has declined over the past 10 years, antibiotics are still overused for many infections. The overuse of antibiotics is a problem because previous antibiotic use is a risk factor for infection with several antibiotic resistant pathogens. This study sought to identify patient and provider factors associated with prescribing antibiotics for emergency department (ED) outpatients with acute respiratory infections of likely non-bacterial etiology. Investigators analyzed VA data for 667 Veterans treated at two VAMC EDs from 6/03 through 6/04, in addition to surveying providers at both sites to collect personal demographics and professional information (e.g., age, medical specialty, and provider type).

Findings show that antibiotic use varied substantially between the two VAMCs and was particularly high for acute bronchitis (97% and 65%). Overall, 26% of the Veterans with upper respiratory infections (URIs) and/or acute bronchitis received antibiotics: 78% for acute bronchitis only, 57% for both infections, and 16% for URIs only. The following factors were associated with prescribing antibiotics for infections of likely non-bacterial etiology: presence of one or more comorbidities, fever, purulent sputum, shortness of breath, altered breath sounds, diagnosis of acute bronchitis, as well as non-internal medicine provider specialty and provider age older than 30.

PubMed Logo Aspinall S, Good C, Metlay J, Mor M, and Fine M. Antibiotic prescribing for presumed non-bacterial acute respiratory infections. The American Journal of Emergency Medicine June 2009;27(5):544-51.

Dr. Aspinall was funded by an HSR&D Research Career Development Award. All authors are part of HSR&D’s Center for Health Equity Research and Promotion.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.