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Antimicrobial prescribing in the USA for adult acute pharyngitis in relation to treatment guidelines

Authors

  • Steven Y. Hong MD MPH,

    Corresponding author
    1. Infectious Diseases Attending, Clinical Instructor in Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
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  • Ying Taur MD MPH,

    1. Infectious Diseases Attending, Clinical Instructor in Medicine, Division of Infectious Diseases, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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  • Michael R. Jordan MD MPH,

    1. Assistant Professor of Medicine/Public Health and Community Medicine, Tufts University School of Medicine, Tufts Medical Center, Boston, MA, USA
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  • Christine Wanke MD

    1. Professor, Departments of Medicine/Public Health and Community Medicine; Director, Division of Nutrition and Infection; Associate Chair, Department of Public Health and Community Medicine, Tufts University School of Medicine, Tufts Medical Center, Boston, MA, USA
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  • Conflict of interest: All authors have no potential conflicts of interest.

Dr Steven Y. Hong, Division of Geographic Medicine and, Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, 150 Harrison Avenue, Jaharis 2, Boston, MA 02111, USA, E-mail: shong@tuftsmedicalcenter.org

Abstract

Rationale, aims and objectives  American College of Physicians (ACP) published guidelines for the diagnosis and treatment of acute pharyngitis in adults in 2001. The objective of this study is to characterize antibiotic prescribing patterns in the USA for acute pharyngitis and evaluate concordance with the 2001 ACP pharyngitis treatment guidelines.

Methods  Patients aged ≥18 years identified with acute pharyngitis via diagnosis codes (ICD-9 CM) were identified from data collected annually (1996–2006) by the National Center for Health Statistics and Centers for Disease Control and Prevention from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Total US office visits for acute pharyngitis were estimated. Logistic regression was performed to determine whether antibiotic prescribing was associated with the publishing of the ACP guidelines.

Results  A total of 3791 office visits met study criteria. We extrapolated 78.0 million visits for acute pharyngitis from 1996 to 2006. Antibiotics were prescribed in 62.6% of cases and 7.5% of cases received ACP-recommended antibiotics. There was a significant decrease in the rate of antibiotic prescriptions from 66.5% to 59.1% after publication of ACP guidelines. Univariate analysis showed that antibiotic prescribing decreased by 27% (OR = 0.73, 95% CI 0.55–0.95, P = 0.021). Multivariate analyses confirmed this finding (OR = 0.72, 95% CI 0.56–0.94, P = 0.014). The prescribing of ACP-recommended antibiotics did not significantly change (8.5% to 6.6%, P = 0.519).

Conclusions  Publishing of ACP guidelines for the diagnosis and treatment of pharyngitis was associated with a decrease in the overall prescribing of antibiotics but not the prescribing of ACP-recommended antibiotics.

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