Outpatient antibiotic prescribing in a low-risk veteran population with acute respiratory symptoms

Acute respiratory tract infections are usually caused by viruses and are self-limited in healthy adults. Providers frequently provide antibiotic prescriptions for sinusitis, bronchitis, pharyngitis, and nonspecific upper respiratory tract infections, despite no evidence of improved clinical outcomes. We sought to determine: 1) primary care providers' antibiotic prescribing practices for acute respiratory tract infections in low-risk outpatient veterans and 2) short-term health outcome differences between those receiving and not receiving an antibiotic prescription.

We performed a retrospective electronic medical record review for veterans presenting to 1 of 3 primary care outpatient Veterans Affairs clinics in Portland, OR between July 1, 2008 and June 30, 2009 for acute respiratory symptoms. Demographics, signs and symptoms, antibiotic prescriptions, nonantibiotic prescriptions, and laboratory and imaging study variables were abstracted from medical charts. Descriptive frequencies, bivariate analyses (t tests, rank sums, Chi square tests, and Fisher's exact tests), and multivariate analyses (logistic regression) were performed.

35.4% of patients received antibiotic prescriptions. Of those antibiotics, 87.8% were not indicated. Antibiotic regimen prescriptions varied widely for each diagnosis. Short-term outcomes of hospitalization, follow-up visits, later antibiotic prescriptions, and death at 30 days were not associated with receipt of antibiotics.

Many low-risk veterans received antibiotics for acute respiratory tract infections despite guidelines indicating that symptomatic treatment is sufficient for most patients. Novel interventions are required to reduce unnecessary and potentially harmful antibiotic use for low-risk outpatients with acute respiratory complaints.