Predictors of antibiotic prescribing for nonspecific upper respiratory infections, acute bronchitis, and acute sinusitis - An UPRNet study

BACKGROUND Antibiotics are often prescribed for viral respiratory infection s. The goal of our study was to determine the factors associated with antib iotic prescribing for acute respiratory infections in primary care. METHODS We performed an observational study in 15 primary care practices in Michigan using patient and physician surveys distributed during visits fur acute respiratory infections, We included patients 4 years or older presen ting with symptoms of an acute respiratory infection (n=482). The main outc ome measures: were prescriptions of antibiotics, signs and symptoms associa ted with antibiotic prescribing, and clinician-reported reasons for prescri bing an antibiotic. RESULTS We found that patients who were older than 18 years, sick for more than 14 days, and seen in urgent care clinics were more likely to receive a ntibiotics. Patients expected antibiotics if they perceived that the drug h ad helped with similar symptoms in the past. In an adjusted model, the vari ables significantly associated with antibiotic prescribing were physical fi ndings of sinus tenderness (odds ratio [OR]=20.0; 95% confidence interval [ CI], 8.3-43.2), rales/rhonchi (OR=19.9; 95% CI, 9.2-43.2), discolored nasal discharge (OR=11.7; 95% CI, 4.3-31.7), and postnasal drainage (OR=3.1; 95% CI, 1.6-6.0). The presence of clear nasal discharge on examination was neg atively associated (OR=0.3; 95% CI, 0.2-0.5). CONCLUSIONS Several physical signs play an important role in clinicians' de cisions to prescribe antibiotics for respiratory infections. This informati on will be useful in designing interventions to decrease inappropriate anti biotic prescribing for upper respiratory infections.