Antibiotic use for acute upper respiratory tract infections in a veteran population

To evaluate the effect of age, symptom duration, symptom presentation, presenting location, and type of acute upper respiratory tract infection (URI) on the receipt of inappropriate antibiotic prescriptions in adult patients.

A retrospective cross-sectional study was conducted within a U.S. Department of Veterans Affairs health system. A total of 500 adult patients with acute URI during a 1-year study period were randomly selected and evaluated for receipt of antibiotic prescriptions. Patients were excluded if they had an indication for antibiotics based on Centers for Disease Control and Prevention criteria, concomitant infection, or unreviewable patient record. Patients were grouped and compared by age, symptom duration, symptom presentation (purulence of secretions), presenting location, and type of URI.

Overall, antibiotics were prescribed to 77% (219 of 283) of patients included in the study. Patients with purulent symptoms received a higher proportion of antibiotic prescriptions compared with those without purulent symptoms (P < 0.01). Patients seen in routine primary care received a lower proportion of antibiotic prescriptions compared with those seen in the emergency department or urgent care/primary care walk-in clinic (P < 0.01). No significant difference was observed in the proportion of antibiotic prescriptions based on symptom duration (P = 0.99) or age (P = 0.19). Patients with acute sinusitis or bronchitis received a higher proportion of antibiotics than those with acute pharyngitis or nonspecific URI (P < 0.01).

Despite evidence-based practice guidelines for the rational use of antibiotics in patients with upper respiratory tract infections, these conditions are being treated inappropriately. Patient and provider factors play a role in the receipt of antibiotics. Further efforts, including those by pharmacists, are needed to improve the use of antibiotics for acute URI in adult patients.