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Comparative Safety and Attributable Healthcare Expenditures Following Inappropriate Versus Appropriate Outpatient Antibiotic Prescriptions Among Adults With Upper Respiratory Infections.
Butler, Anne M; Brown, Derek S; Newland, Jason G; Nickel, Katelin B; Sahrmann, John M; O'Neil, Caroline A; Olsen, Margaret A; Zetts, Rachel M; Hyun, David Y; Durkin, Michael J.
Affiliation
  • Butler AM; Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA.
  • Brown DS; Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.
  • Newland JG; Brown School, Washington University, St. Louis, Missouri, USA.
  • Nickel KB; Department of Pediatrics, Washington University School of Medicine, St. Louis, St. Louis, Missouri, USA.
  • Sahrmann JM; Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA.
  • O'Neil CA; Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA.
  • Olsen MA; Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA.
  • Zetts RM; Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA.
  • Hyun DY; Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.
  • Durkin MJ; The Pew Charitable Trusts, Washington, DC, USA.
Clin Infect Dis ; 76(6): 986-995, 2023 03 21.
Article in En | MEDLINE | ID: mdl-36350187
BACKGROUND: Little is known about the clinical and financial consequences of inappropriate antibiotics. We aimed to estimate the comparative risk of adverse drug events and attributable healthcare expenditures associated with inappropriate versus appropriate antibiotic prescriptions for common respiratory infections. METHODS: We established a cohort of adults aged 18 to 64 years with an outpatient diagnosis of a bacterial (pharyngitis, sinusitis) or viral respiratory infection (influenza, viral upper respiratory infection, nonsuppurative otitis media, bronchitis) from 1 April 2016 to 30 September 2018 using Merative MarketScan Commercial Database. The exposure was an inappropriate versus appropriate oral antibiotic (ie, non-guideline-recommended vs guideline-recommended antibiotic for bacterial infections; any vs no antibiotic for viral infections). Propensity score-weighted Cox proportional hazards models were used to estimate the association between inappropriate antibiotics and adverse drug events. Two-part models were used to calculate 30-day all-cause attributable healthcare expenditures by infection type. RESULTS: Among 3 294 598 eligible adults, 43% to 56% received inappropriate antibiotics for bacterial and 7% to 66% for viral infections. Inappropriate antibiotics were associated with increased risk of several adverse drug events, including Clostridioides difficile infection and nausea/vomiting/abdominal pain (hazard ratio, 2.90; 95% confidence interval, 1.31-6.41 and hazard ratio, 1.10; 95% confidence interval, 1.03-1.18, respectively, for pharyngitis). Thirty-day attributable healthcare expenditures were higher among adults who received inappropriate antibiotics for bacterial infections ($18-$67) and variable (-$53 to $49) for viral infections. CONCLUSIONS: Inappropriate antibiotic prescriptions for respiratory infections were associated with increased risks of patient harm and higher healthcare expenditures, justifying a further call to action to implement outpatient antibiotic stewardship programs.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Respiratory Tract Infections / Bacterial Infections / Pharyngitis / Drug-Related Side Effects and Adverse Reactions / Influenza, Human Type of study: Guideline / Health_economic_evaluation / Prognostic_studies Limits: Adult / Humans Language: En Journal: Clin Infect Dis Journal subject: DOENCAS TRANSMISSIVEIS Year: 2023 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Respiratory Tract Infections / Bacterial Infections / Pharyngitis / Drug-Related Side Effects and Adverse Reactions / Influenza, Human Type of study: Guideline / Health_economic_evaluation / Prognostic_studies Limits: Adult / Humans Language: En Journal: Clin Infect Dis Journal subject: DOENCAS TRANSMISSIVEIS Year: 2023 Document type: Article Affiliation country: Country of publication: