ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2020
Reducing Antibiotic Use in Ambulatory Care Through Influenza Vaccination.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 14 citations in OpenAlex.
- Prevention of antimicrobial prescribing among infants following maternal vaccination against respiratory syncytial virus.Proceedings of the National Academy of Sciences of the United States of America · 2022Trial
- Charting new territory: outpatient stewardship in immunocompromised patients (first of a two-part series).Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Review
- Combating antimicrobial resistance in Asia: A comprehensive review of strategic action plans, policies, and the role of the WHO.Saudi medical journal · 2025Review
- Pediatric Antibiotic Use Associated With Respiratory Syncytial Virus and Influenza in the United States, 2008-2018.The Journal of infectious diseases · 2025Article
- Factors associated with antibiotic use in children hospitalized for acute viral gastroenteritis and the relation to rotavirus vaccination.Human vaccines & immunotherapeutics · 2024Article
- Estimating the full health and economic benefits of current and future influenza vaccines.BMC medicine · 2023Article
- Expert consensus on monitoring antimicrobial stewardship in French nursing homes using assessed reimbursement database indicators.JAC-antimicrobial resistance · 2023Article
- Clinical and economic burden of physician-diagnosed influenza in adults during the 2017/2018 epidemic season in Spain.BMC public health · 2022Article
- Influenza-associated severe acute respiratory infections among children under five years old in Morocco, September 2017 to March 2019.Le infezioni in medicina · 2022Article
Corrections and comments
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Authors and funding
16 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundImproving appropriate antibiotic use is crucial for combating antibiotic resistance and unnecessary adverse drug reactions. Acute respiratory illness (ARI) commonly causes outpatient visits and accounts for ~41% of antibiotics used in the United States. We examined the influence of influenza vaccination on reducing antibiotic prescriptions among outpatients with ARI.
methodsWe enrolled outpatients aged ≥6 months with ARI from 50-60 US clinics during 5 winters (2013-2018) and tested for influenza with RT-PCR; results were unavailable for clinical decision making and clinical influenza testing was infrequent. We collected antibiotic prescriptions and diagnosis codes for ARI syndromes. We calculated vaccine effectiveness (VE) by comparing vaccination odds among influenza-positive cases with test-negative controls. We estimated ARI visits and antibiotic prescriptions averted by influenza vaccination using estimates of VE, coverage, and prevalence of antibiotic prescriptions and influenza.
resultsAmong 37 487 ARI outpatients, 9659 (26%) were influenza positive. Overall, 36% of ARI and 26% of influenza-positive patients were prescribed antibiotics. The top 3 prevalent ARI syndromes included: viral upper respiratory tract infection (47%), pharyngitis (18%), and allergy or asthma (11%). Among patients testing positive for influenza, 77% did not receive an ICD-CM diagnostic code for influenza. Overall, VE against influenza-associated ARI was 35% (95% CI, 32-39%). Vaccination prevented 5.6% of all ARI syndromes, ranging from 2.8% (sinusitis) to 11% (clinical influenza). Influenza vaccination averted 1 in 25 (3.8%; 95% CI, 3.6-4.1%) antibiotic prescriptions among ARI outpatients during influenza seasons.
conclusionsVaccination and accurate influenza diagnosis may curb unnecessary antibiotic use and reduce the global threat of antibiotic resistance.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.