Assessment of antibiotic prescription in acute respiratory infections in adults

Objective: This study aims to ascertain the variability in the use of antib iotics for the treatment of acute respiratory infections in several hospita l emergency services in Spain, as well as the appropriateness of antibiotic s prescription through evaluation by a panel of experts using available sci entific evidence. Method: A cross-sectional study was carried out in the emergency services o f 10 hospitals in different Spanish regions. We chose patients diagnosed as having acute respiratory infection, aged over 14 years. Among the collecte d variables were: type of respiratory infection, antibiotic prescription, c omorbidity, qualification of the prescribing doctor and hospital admission. The consensus conference held by a panel of experts established first choi ce treatment and the alternative and inappropriate use for each respiratory infection, based on the available scientific evidence. All the observed pr escriptions in our study were classified according to this pattern. Results: A sample of 2899 acute respiratory infections was studied (5.5% of all emergencies). Antibacterial agent treatment was prescribed in 82.6% of these, varying according to the infection between 98.5% of pneumonias and 49% of croup-influenza-common cold. The most commonly used antibiotics were amoxicillin-clavulanate and cefuroxime, The global percentage of inappropr iate prescription was 40.5% (95% CI; 35.4-45.5), The prescriptions were ina ppropriate in 16.9% of cases of pharyngotonsillitis, 17.8% of chronic bronc hitis, 26.9% of acute bronchitis, 29.3% of pneumonias, 30.8% of otitis and sinusitis and in 70.8% of croup, flu, common cold and non-specified infecti ons. Significant variability among participating centres was observed, both in choice of antibiotics and in their degree of appropriateness. Conclusions: There is excessive use of antimicrobial drugs in acute respira tory infections, and the majority are used for viral infections. There is i ndiscriminate use of broad spectrum antibiotics, which are valid in some in fections but clearly inappropriate in others. Similarly there are important differences in the choice of antibiotics and their degree of appropriatene ss among hospitals, (C) 2000 The British Infection Society.