Concurrent acute illness and comorbid conditions poorly predict antibiotic use in upper respiratory tract infections: a cross-sectional analysis

Ilene H Zuckerman; Eli N Perencevich; Anthony D Harris

doi:10.1186/1471-2334-7-47

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Concurrent acute illness and comorbid conditions poorly predict antibiotic use in upper respiratory tract infections: a cross-sectional analysis

Journal article

Open access

Peer reviewed

Concurrent acute illness and comorbid conditions poorly predict antibiotic use in upper respiratory tract infections: a cross-sectional analysis

Ilene H Zuckerman, Eli N Perencevich and Anthony D Harris

BMC infectious diseases, Vol.7(1), 47

05/30/2007

DOI: 10.1186/1471-2334-7-47

PMCID: PMC1892779

PMID: 17537245

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Abstract

Inappropriate antibiotic use promotes resistance. Antibiotics are generally not indicated for upper respiratory infections (URIs). Our objectives were to describe patterns of URI treatment and to identify patient and provider factors associated with antibiotic use for URIs. This study was a cross-sectional analysis of medical and pharmacy claims data from the Pennsylvania Medicaid fee-for-service program database. We identified Pennsylvania Medicaid recipients with a URI office visit over a one-year period. Our outcome variable was antibiotic use within seven days after the URI visit. Study variables included URI type and presence of concurrent acute illnesses and chronic conditions. We considered the associations of each study variable with antibiotic use in a logistic regression model, stratifying by age group and adjusting for confounders. Among 69,936 recipients with URI, 35,786 (51.2%) received an antibiotic. In all age groups, acute sinusitis, chronic sinusitis, otitis, URI type and season were associated with antibiotic use. Except for the oldest group, physician specialty and streptococcal pharyngitis were associated with antibiotic use. History of chronic conditions was not associated with antibiotic use in any age group. In all age groups, concurrent acute illnesses and history of chronic conditions had only had fair to poor ability to distinguish patients who received an antibiotic from patients who did not. Antibiotic prevalence for URIs was high, indicating that potentially inappropriate antibiotic utilization is occurring. Our data suggest that demographic and clinical factors are associated with antibiotic use, but additional reasons remain unexplained. Insight regarding reasons for antibiotic prescribing is needed to develop interventions to address the growing problem of antibiotic resistance.

Cross-Sectional Studies

Humans

Middle Aged

Child, Preschool

Infant

Male

Respiratory Tract Infections - drug therapy

Drug Utilization Review

Drug Utilization

Pennsylvania

Anti-Bacterial Agents - therapeutic use

Practice Patterns, Physicians' - statistics & numerical data

Regression Analysis

Adolescent

Adult

Female

Respiratory Tract Infections - complications

Medicaid

Child

Databases, Factual

Details

Title: Subtitle: Concurrent acute illness and comorbid conditions poorly predict antibiotic use in upper respiratory tract infections: a cross-sectional analysis
Creators: Ilene H Zuckerman - University of Maryland, Baltimore
Eli N Perencevich - University of Maryland, Baltimore
Anthony D Harris - University of Maryland, Baltimore
Resource Type: Journal article
Publication Details: BMC infectious diseases, Vol.7(1), 47
DOI: 10.1186/1471-2334-7-47
PMID: 17537245
PMCID: PMC1892779
NLM abbreviation: BMC Infect Dis
ISSN: 1471-2334
eISSN: 1471-2334
Publisher: England
Language: English
Date published: 05/30/2007
Academic Unit: Epidemiology; Internal Medicine
Record Identifier: 9983779291602771

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14 Times Cited - Web of Science