Decreasing Inappropriate Antibiotic Prescribing for Viral Upper Respiratory Infections

It is largely common knowledge that overprescribing antibiotics does more harm than good. Too many antibiotics can help dangerous pathogens mutate to develop antimicrobial resistance. Unnecessary antibiotic prescribing is an urgent threat to global health, with antibiotic-resistant infections causing 1.27 million deaths a year.

Inappropriate antibiotic prescribing for viral upper respiratory tract infections (URTIs) is one area of concern. One study, presented at the ongoing Society for Healthcare Epidemiology of America (SHEA) 2023 Spring Conference, sought to reduce inappropriate prescribing of antibiotics for viral URTIs at primary care facilities in Mayo Clinic Arizona.

The goal of this research was to reduce inappropriate prescribing by 22% in 2022, down from a baseline of 23% in 2021 to a goal rate of 18% in 2022.

International Classification of Diseases, Tenth Revision (ICD-10) codes divide respiratory infections into 3 tiers:

• Tier 1, “always prescribe” (e.g., pneumonia)
• Tier 2, “sometimes prescribe” (e.g., otitis media)
• Tier 3, “never prescribe” (e.g., bronchitis)

In this Mayo Clinic study, the investigators noted that diagnostic codes for URTIs commonly caused by viruses were categorized as Tier 3. They defined inappropriate prescribing rate as the number of Tier 3 encounters resulting in a prescription for a URTI antibiotic over the total number of Tier 3 encounters.

The antibiotic stewardship intervention was comprised of baseline education, promotion of syndrome-specific order panels, and dissemination of peer comparison reports. It was implemented across Mayo Clinic Arizona primary care departments, including Family Medicine, Community Internal Medicine, Emergency Medicine, and Women’s Health Internal Medicine. Each department was briefed on the intervention, and department education was completed by June 2022.

The annual antibiotic prescribing rate for Tier 3 encounters was successfully reduced by 29%, from a baseline rate of 23.6% in 2021 to 16.4% in 2022. The post-education prescribing rate (June 2022-December 2022) was 13.1%.

The syndromic ambulatory order panel (EZ ID Respiratory Order Panel) was used an average of 13.3 times a month in 2022, up from just 1.5 uses/month in 2021. Notably, repeat health care contact for URTIs within 2 weeks of Tier 3 encounters did not differ between patients who were prescribed an antibiotic in 2022 and patients who were not.

The investigators concluded that their intervention significantly reduced inappropriate antibiotic prescribing for viral upper respiratory tract infections, even exceeding their goal.

This study was presented during a poster session at the Society for Healthcare Epidemiology of America (SHEA) 2023 Spring Conference.