TABLE 1

Domains of Inappropriate Antibiotic Prescribing

Types of Inappropriate Antibiotic PrescribingFactors 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