Antibiotic prescribing in ambulatory care settings for adults with colds, upper respiratory tract infections, and bronchitis

Background. Imprudent prescribing of antibiotics for patients with colds, upper respiratory tract infections (URIs), and bronchitis may contribute to antibiotic resistance and waste economic resources. Objective: The purpose of this study was to determine the antibiotic prescribing rate for adults diagnosed with colds, URIs, and bronchitis in 1996 and to compare these rates with those reported for 1992. Methods: This was a retrospective. cross-sectional analysis of a US government database of ambulatory physician practices. The number of adults (greater than or equal to18 years of age) with a diagnosis of cold, URI, or bronchitis and the percentage receiving antibiotics were determined from the 1996 National Ambulatory Medical Care Survey (NAMCS). The antibiotic prescribing rate was the main outcome measure. Results: In 1996, similar to13.9 million office visits resulted in a primary diagnosis of cold, URI, or acute bronchitis; of these visits. 46%, 47%, and 60%, respectively, resulted in the prescribing of an antibiotic. The respective rates in 1992 were 51%, 52%, and 66%. The rates of antibiotic prescribing were 12% to 16% higher when all drugs, not just the first drug listed in the NAMCS database, were analyzed. In 1996, antibiotic prescribing rates for persons 45 to 64 years of age and persons >64 years of age were significantly lower than for those aged 18 to 44 years. Conclusions: The rates of potentially inappropriate antibiotic prescribing decreased modestly from 1992 to 1996: however, previous rates may have been underestimated. The antibiotic prescribing rates for colds, URIs, and acute bronchitis may be as high as 61%, 63%, and 72%, respectively, when all drug information is analyzed. Antibiotics are over-prescribed, which may increase antibiotic resistance and waste health care resources.