Geographic Variability in Diagnosis and Antibiotic Prescribing for Acute Respiratory Tract Infections

Adam L Hersh, Daniel J Shapiro, Andrew T Pavia, Katherine E Fleming-Dutra, Lauri A Hicks, Adam L Hersh, Daniel J Shapiro, Andrew T Pavia, Katherine E Fleming-Dutra, Lauri A Hicks

Abstract

Introduction: Antibiotic prescribing rates vary substantially across regions in the USA. Whether these differences are driven primarily by a greater tendency to treat certain infections (i.e., overtreatment) in certain regions or differences in the tendency to diagnose certain infections (i.e., overdiagnosis) is poorly understood.

Methods: We examined data from 2012 to 2013 using the National Ambulatory Medical Care Survey, which is a nationally representative sample of visits to office-based physicians. For each of nine geographic regions, we examined the relationship between the visit rate/1000 population for respiratory diagnoses for which antibiotics were prescribed to the visit rate/1000 population for selected respiratory diagnoses where antibiotic therapy may be warranted.

Results: The visit rate for all respiratory conditions resulting in an antibiotic prescription was lowest (109/1000 population) in the Pacific Region and highest (176/1000, 95% CI 138-213) in the East South Central Region. The diagnosis rate for selected respiratory conditions where antibiotic therapy may be warranted was also lowest (119/1000, 95% CI 91-147) in the Pacific Region and highest (189/1000, 95% CI 153-225) in the East South Central Region.

Conclusion: Antibiotic prescribing rates for respiratory conditions vary by region and are strongly associated with the rate with which selected respiratory conditions are diagnosed.

Keywords: Antibiotic; Infection; Respiratory tract infections; Stewardship.

Figures

Fig. 1
Fig. 1
a Regional variation in the rate of all respiratory visits prescribed antibiotics per 1000 population. b Regional variation in the rate of ARTI+ visits (regardless of antibiotic prescription) per 1000 population. ARTI+ acute respiratory tract infections for which antibiotic therapy may be warranted. New England (CT, MA, ME/NH/RI/VT). Middle Atlantic (NJ, NY, PA). East North Central (IL, IN, MI, OH, WI). West North Central (IA, KS, MN, MO, NE/ND/SD). South Atlantic (FL, GA, MD, NC, SC, VA, DC/DE/WV). East South Central (AL, KY, MS, TN). West South Central (AR, LA, OK, TX). Mountain (AZ, CO, UT, ID/NM/MT/NV/WY). Pacific (CA, OR, WA, AK/HI)
Fig. 2
Fig. 2
Correlation between the ARTI visit rate per 1000 population and the rate with which all respiratory visits are prescribed antibiotics per 1000 population. ARTI+ acute respiratory tract infections for which antibiotic therapy may be warranted

References

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Source: PubMed

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