Outpatient antibiotic use for acute respiratory tract infections: seasonal trends, and implications for care & quality
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Abstract
Acute respiratory tract infection (ARI) is the most common reason for outpatient medical visits in the United States, and frequently results in treatment with an antibiotic. Most ARIs have a viral etiology, thus antibiotic therapy will have little clinical benefit in these cases. It is estimated as much as one-half of all antibiotic utilization for ARI in outpatient settings is inappropriate. Importantly, this misuse is thought to be the primary driver of antibiotic resistance development among bacteria. Antibiotic resistant infections cause an estimated 2 million illnesses and 23,000 deaths annually in the United States, and associated costs exceed $30 billion. Despite our current understanding of relevant predictors of appropriate antibiotic use, less is known regarding seasonality. This dissertation explores effects of seasonality on antibiotic prescribing in three aspects: 1) seasonal variation in appropriateness of prescribing, and antibiotics prescribed among common ARIs; 2) specific predictors of observed seasonal variation in prescribing practices; and 3) implications of seasonality for guideline concordance & quality of care. Findings generated herein, could help inform interventions designed to promote more judicious use of antibiotics in healthcare.