Inappropriate use of antibiotics for acute respiratory tract infections in a rural emergency department

Introduction: Evidence-based reviews and guidelines recommend lowering antibiotic prescription rates for acute respiratory tract infections (ARIs). Objective: To determine the number of patients presenting with uncomplicated ARIs at the walk-in emergency department (ED) of a rural community health centre and to determine the antibiotic prescription rate for each type of ARI. Methods: A one-year retrospective data collection of a rural ED was carried out using MEDITECH and chart review to determine numbers of patients presenting with an ARI; antibiotic prescriptions were recorded according to ARI diagnosis. Results: ARIs accounted for 22% of all patients seen by the ED doctor. In 57% of the ARIs diagnosed, patients were prescribed an antibiotic. Individual rates ranged from 2% for influenza to 100% for pneumonia. A breakdown of rates for each type of ARI is provided. Conclusions: Antibiotic prescription rates for ARIs remain high, with some ARIs being more inappropriately managed than others. The rate of patients presenting with ARIs to the study ED was higher than in some other EDs, possibly reflecting the problems of recruiting and retaining family doctors in many rural areas, including ours.