A retrospective review of antibiotic use for acute respiratory infections in urgent-care patients

Abstract Objective: We examined the use of antibiotics for acute respiratory infections in an urgent-care setting. Design: Retrospective database review. Setting: The study was conducted in 2 urgent-care clinics staffed by academic emergency physicians in San Diego, California. Patients: Visits for acute respiratory infections were identified based on presenting complaints. Methods: The primary outcome was a discharge prescription for an antibiotic. The patient and provider characteristics that predicted this outcome were analyzed using logistic regression. The variation in antibiotic prescriptions between providers was also analyzed. Results: In total, 15,160 visits were analyzed. The patient characteristics were not predictive of antibiotic treatment. Physicians were more likely than advanced practice practitioners to prescribe antibiotics (1.31; 95% confidence interval [CI], 1.21–1.42). For every year of seniority, a provider was 1.03 (95% CI, 1.02–1.03) more likely to prescribe an antibiotic. Although the providers saw similar patients, we detected significant variation in the antibiotic prescription rate between providers: the mean antibiotic prescription rate within the top quartile was 54.3% and the mean rate in the bottom quartile was 21.7%. Conclusions: The patient and provider characteristics we examined were either not predictive or were only weakly predictive of receiving an antibiotic prescription for acute respiratory infection. However, we detected a marked variation between providers in the rate of antibiotic prescription. Provider differences, not patient differences, drive variations in antibiotic prescriptions. Stewardship efforts may be more effective if directed at providers rather than patients.