Related Experiment Video
Updated: Dec 7, 2025
Author Spotlight: Advancing Rapid Detection of Respiratory Pathogens Using Microfluidic Chip
Published on: March 29, 2024
Hospitalization for Acute Respiratory Tract Infection in a Low-Antibiotic-Prescribing Setting: Cross-Sectional Data
Christin Löffler1, Attila Altiner1, Annette Diener1
1Institute of General Practice, Rostock University Medical Center, 18057 Rostock, Germany.
Background:
Acute respiratory tract infections (ARTI) are the main cause of inappropriate antibiotic prescribing. To date, there is limited evidence concerning whether low levels of antibiotic prescribing may impact patient safety. We investigate whether antibiotic prescribing for patients seeking primary care for ARTI correlates with the odds for hospitalization.
Methods:
Analysis of patient baseline data (n = 3669) within a cluster-randomized controlled trial. Adult patients suffering from ARTI in German primary care are included. The main outcome measure is acute hospitalization for respiratory infection and for any acute disease from 0 to 42 days after initial consultation.
Results:
Neither the antibiotic status of individual patients (OR 0.91; 95% CI: 0.49 to 1.69; p-value = 0.769) nor the physician-specific antibiotic prescription rates for ARTI (OR 1.22; 95% CI: 1.00 to 1.49; p-value = 0.054) had a significant effect on hospitalization. The following factors increased the odds for hospitalization: patient's age, the ARTI being defined as lower respiratory tract infections (such as bronchitis) by the physician, the physician's perception of disease severity, and being cared for within group practices (versus treated in single-handed practices).
Conclusions:
In a low-antibiotic-prescribing primary care setting such as Germany, lack of treatment with antibiotics for ARTI did not result in higher odds for hospitalization in an adult population.
Insights
Inappropriate antibiotic prescribing for acute respiratory tract infections (ARTI) is common. This study found that not prescribing antibiotics for ARTI in adults did not increase hospitalization rates in a low-prescribing setting.
Area of Science:
- General Practice
- Infectious Diseases
- Public Health
Background:
- Acute respiratory tract infections (ARTI) are a primary driver of unnecessary antibiotic prescriptions.
- Evidence is limited regarding the patient safety implications of low antibiotic prescribing rates for ARTI.
- This study examines the association between antibiotic prescribing for ARTI and hospitalization risk in primary care.
Purpose of the Study:
- To investigate the correlation between antibiotic prescribing for ARTI and the odds of hospitalization in adult patients.
- To assess patient safety outcomes in a primary care setting with historically low antibiotic prescribing rates.
Main Methods:
- Analysis of baseline data from 3669 adult patients with ARTI in German primary care, as part of a cluster-randomized controlled trial.
- Primary outcome measure: acute hospitalization for respiratory infection or any acute disease within 42 days of initial consultation.
- Evaluation of individual antibiotic use and physician-specific prescription rates.
Main Results:
- Neither individual antibiotic use (OR 0.91) nor physician prescription rates (OR 1.22) significantly impacted hospitalization odds.
- Factors increasing hospitalization odds included older patient age, lower respiratory tract infections, physician-perceived disease severity, and group practice settings.
- The p-value for physician-specific rates was 0.054, indicating a trend towards increased hospitalization with higher prescribing, but not statistically significant.
Conclusions:
- In a low-antibiotic-prescribing environment like Germany, withholding antibiotics for ARTI in adults does not elevate hospitalization risk.
- Patient factors and clinical judgment, rather than antibiotic prescribing levels, appear to be stronger predictors of hospitalization for ARTI.
- Findings support conservative antibiotic prescribing for ARTI in primary care without compromising patient safety regarding hospitalization.
Related Concept Videos
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:30Acute Pharyngitis
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
01:26Tonsillitis II: Management
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...
01:28Acute Pyelonephritis II: Diagnostic Studies and Management