Inappropriate Antibiotic Prescribing: Wind at Our Backs or Flapping in the Breeze?

Article Figures & Data

TABLE 1

Domains of Inappropriate Antibiotic Prescribing

Types of Inappropriate Antibiotic Prescribing	Factors That May Be Associated With Inappropriate Prescribing
Unnecessary antibiotic prescribing: prescribing for a condition where an antibiotic is not indicated.	Clinical factors
Example: prescribing an antibiotic for a viral upper respiratory infection.	Patient age
Inappropriate antibiotic selection: use of nonguideline recommended agent for a specific condition that does warrant treatment (often an unnecessarily broad-spectrum agent when narrower-spectrum agents are recommended).	Severity of illness
Example: prescribing azithromycin for pharyngitis caused by group A Streptococcus.	Previous infection history
Inappropriately prolonged duration of therapy (when shorter-course therapy is equally effective).	Recent antibiotic exposure
Example: use of 2 wk of antibiotic therapy for cellulitis or sinusitis.	Immunocompromised status
Inappropriate antibiotic route: use of intravenous or intramuscular agents when oral agents are likely to be equally effective.	Nonclinical factors
Example: use of a complete course of intravenous antibiotic therapy instead of conversion to oral therapy for osteomyelitis.	Patient race or insurance status
	Geographic region of visit
	Time of day
	Experience level of provider
	Type of provider (advanced practice provider versus physician)
	Academic versus nonacademic practice
	Urban versus rural location
	Provider perceptions of parental expectations for antibiotics
	Medication cost
	Medication dosing interval and side-effect profile