Antibiotic Prescribing Among Outpatients With Acute Respiratory Infections

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Although acute respiratory infections (ARIs) are often caused by viruses for which antibiotics are not effective, antibiotics remain commonly prescribed for ARIs.

Antibiotics are commonly prescribed for acute respiratory infections (ARIs); however, ARIs are often caused by viruses that antibiotics cannot treat. A recent study in JAMA Network Open aimed to characterize antibiotic prescribing among outpatients with ARIs during influenza season and to identify targets for reducing inappropriate antibiotic prescribing for common ARI diagnoses.

The study enrolled outpatients aged 6 months or older who were assessed with an ARI at outpatient clinics associated with 5 US influenza Vaccine Effectiveness Network sites during the 2013-2014 and 2014-2015 influenza seasons. The researchers collected data on the antibiotic prescriptions, medical history, and International Classification of Diseases, Ninth Revision diagnosis codes from medical and pharmacy records, in addition to group A streptococcal (GAS) testing results in a patient subset.

“Inappropriate antibiotic use contributes to the development of antibiotic-resistant organisms, which cause an estimated 2 million illnesses and 23,000 deaths annually in the United States,” the authors explained. "Understanding antibiotic prescribing practices for ARIs in outpatient settings is critical to designing strategies for reducing inappropriate antibiotic use.”


There was a total of 14,987 patients with an ARI included in the study and 6136 (41%) were prescribed an antibiotic. Of the 6136 patients, 2522 (41%) had diagnoses for which antibiotics are not indicated, 2106 (84%) of these patients were diagnosed as having a viral upper respiratory tract infection or bronchitis (acute or not otherwise specified).

Of the 3306 patients (22%) not diagnosed as having pneumonia and who had laboratory-confirmed influenza, 945 (29%) were prescribed an antibiotic, accounting for 17% of all antibiotic prescriptions among patients with nonpneumonia ARI. Furthermore, among the 1248 patients with pharyngitis, 1137 (91%) had GAS testing, 440 of the 1248 patients (35%) were prescribed antibiotics, and among them 168 (38%) had negative results on GAS testing.

Also, of the 1200 patients with sinusitis and no other indication for antibiotic treatment who received an antibiotic, 454 (38%) had symptoms for 3 days or less prior to the outpatient visit, suggesting acute viral sinusitis not requiring antibiotics, according to the results.

“Identified targets for improved outpatient antibiotic stewardship include eliminating antibiotic treatment of viral upper respiratory tract infections and bronchitis and improving adherence to prescribing guidelines for pharyngitis and sinusitis,” concluded the authors. “Increased access to sensitive and timely virus diagnostic tests, particularly for influenza, may reduce unnecessary antibiotic use for these syndromes.”

The researchers emphasized that their results indicates a number of potential targets to achieve the goal of the National Action Plan for Combating Antibiotic-Resistant Bacteria of reducing inappropriate outpatient antibiotic use by 50% by 2020.


Havers FP, Hicks LA, Chung JR, et al. Outpatient antibiotic prescribing for acute respiratory infections during influenza seasons. JAMA Network Open. 2018;1(2):e180243. doi:10.1001/jamanetworkopen.2018.0243.