963. Antibiotic Prescribing for Adults with Acute Bronchitis in the United States, 1996-2010
Session: Poster Abstract Session: Stewardship: Epidemiology of Antibiotic Use
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 963_IDWPOSTER.pdf (7.5 MB)
  • Background: Guidelines state and performance measures assert that antibiotics are not indicated for acute bronchitis. Efforts to decrease antibiotic prescribing for acute bronchitis have been underway for over 15 years.

    Methods: We performed a cross-sectional analysis of the nationally representative National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey of visits by adults aged 19-64 years old with a diagnosis of acute bronchitis (ICD-9 466.x) to primary care physicians and emergency departments (EDs) between 1996 and 2010 (n = 3,667 sampled visits). We excluded visits by patients with chronic lung disease, cancer, antibiotic-appropriate conditions, or immunosuppression. We calculated visits and antibiotic prescribing rates accounting for the multistage probability design of the surveys.

    Results: Between 1996 and 2010, there were 39 million (95% confidence interval [CI], 33 to 45 million) visits to outpatient offices and EDs for acute bronchitis. There was a significant increase in the number of primary care visits for acute bronchitis between 1996 (1.1 million visits; 95% CI, 0.4 to 1.8 million) and 2010 (3.4 million visits; 95% CI, 1.9 to 4.9; p < 0.001), but not ED visits (620 thousand annually; 95% CI, 260 to 725 thousand). Physicians prescribed antibiotics at 73% (95% CI, 69% to 77%) of visits. From 1996 to 2010, the overall national antibiotic prescribing rate did not change (p=0.25), but the prescribing rate in EDs increased from 69% to 73% (p=0.02). Physicians increasingly prescribed extended spectrum macrolides from 1996 (25% of visits; 95% CI, 18% to 33%) of visits to 2010 (41%; 95% CI, 32% to 51%; p for trend = 0.04). There was no change in physician prescribing of other antibiotic classes (37% of visits; 95% CI, 32% to 42%; p for trend = 0.48). After extended spectrum macrolides, physicians most commonly prescribed fluoroquinolones (11% of all visits), aminopenicillins (7%), and cephalosporins (7%).

    Conclusion: Despite guidelines and performance measures stating that antibiotics are not indicated for acute bronchitis, physicians prescribed antibiotics at 73% of visits, a rate that did not change from 1996 to 2010. Physicians frequently prescribed broad-spectrum, expensive antibiotics for acute bronchitis.

    Michael Barnett, MD and Jeffrey Linder, MD, MPH, FACP, Brigham & Women's Hospital, Boston, MA

    Disclosures:

    M. Barnett, None

    J. Linder, None

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