Authors: Vanderweil, Stefan G.¹; Pelletier, Andrea J.¹; Hamedani, Azita G.¹; Gonzales, Ralph²; Metlay, Joshua P.³; Camargo, Carlos A.¹

Source: Academic Emergency Medicine, Volume 14, Number 4, April 2007 , pp. 366-369(4)

Publisher: Wiley-Blackwell

Abstract:

Objectives: To examine antibiotic prescribing trends for U.S. emergency department (ED) visits with upper respiratory tract infections (URIs) between 1993 and 2004.

Methods: Data were compiled from the National Hospital Ambulatory Medical Care Survey (NHAMCS). URI visits were identified by using ICD-9-CM code 465.9, whereas antibiotics were identified using the National Drug Code Directory class Antimicrobials. A multivariate logistic regression model revealed sociodemographic and geographic factors that were independently associated with receipt of an antibiotic prescription for URIs.

Results: There were approximately 23.4 million ED visits diagnosed as URIs between 1993 and 2004. Although the proportion of URI diagnoses remained relatively stable (p trend = 0.26), a significant decrease in provision of antibiotic prescriptions for URIs occurred during this 12-year period, from a maximum of 55% in 1993, to a minimum of 35% in 2004. Patients who were prescribed antibiotics were more likely to be white than African American and to have been treated in EDs located in the southern United States.

Conclusions: Antibiotic prescribing for URIs continues to decrease, a favorable trend that suggests that national efforts to reduce inappropriate antibiotic usage are having some success. Nevertheless, the frequency of antibiotic treatment for URI in the ED remains high (35%). Future efforts to reduce inappropriate antibiotic prescribing may focus on patients and physicians in southern U.S. EDs. Additional work is needed to address continued evidence of race-related disparities in care.

Keywords: respiratory tract infections; antibiotics; emergency departments; NHAMCS

Document Type: Research article

DOI: http://dx.doi.org/10.1197/j.aem.2006.10.096

Affiliations: 1: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 2: Division of General Internal Medicine, Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 3: Philadelphia Veterans Affairs Medical Center and the Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA

Publication date: 2007-04-01

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