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 |