ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2023
Comparative Safety and Attributable Healthcare Expenditures Following Inappropriate Versus Appropriate Outpatient Antibiotic Prescriptions Among Adults With Upper Respiratory Infections.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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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
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- Prevalence and healthcare burden of inappropriate antimicrobial treatment in patients at high risk of complications from acute respiratory infections: a scoping review.Frontiers in medicine · 2025Pooled it
- Estimating cost savings from reducing antibiotic overprescription in european general practices.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
- Assessment of Antimicrobial Transition Errors from Hospitals to Skilled Nursing Facilities.Open forum infectious diseases · 2026Article
- Comparative Safety of Different Antibiotic Regimens for the Treatment of Outpatient Community-Acquired Pneumonia Among Otherwise Healthy Adults.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Inappropriate antibiotic prescribing for acute respiratory illnesses in outpatient settings in New York City, 2019-2022.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Clinical utility of a host-protein test for suspected infection in the pediatric emergency department: a pragmatic pre-/post-implementation study.Frontiers in pediatrics · 2026Article
- Point-Of-Care Respiratory Diagnosis and Antibiotic Utilization in the Emergency Department: A Prospective Evaluation of Multiplex PCR.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Article
- The role of electronic health records systems in de-implementing low-value care in primary care: a scoping review.Implementation science communications · 2025Review
- Multicenter clinical performance and comparative evaluation of the LIAISON PLEX RespiratoryJournal of clinical microbiology · 2025Article
- Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Patients with Irritable Bowel Syndrome.Digestion · 2025Article
- Real-World Utility of the Host-Response MeMed BV Test in a Pediatric Emergency Department: A Non-Randomized Study with Optimized Antimicrobial and Diagnostic Stewardship.Children (Basel, Switzerland) · 2025Article
- Antimicrobial use for influenza-like illnesses in Nha Trang, Vietnam: a cross-sectional study.BMJ open · 2025Observational
- Clinicians' Reasons for Non-Visit-Based, No-Infectious-Diagnosis-Documented Antibiotic Prescribing: A Sequential Mixed-Methods Study.Antibiotics (Basel, Switzerland) · 2025Article
- Real-world interpretation of procalcitonin to guide antibiotic prescribing: a retrospective cohort study with regression discontinuity analysis.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Examining the impact of treatment guidelines on outpatient antibiotic prescription trends at a cancer center in Pakistan.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- The hidden economic and environmental costs of antimicrobial therapies: a call to action.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Durations of Antibiotic Treatment for Acute Otitis Media and Variability in Prescribed Durations Across Two Large Academic Health Systems.Journal of the Pediatric Infectious Diseases Society · 2024Article
- Leveraging Health Systems to Expand and Enhance Antibiotic Stewardship in Outpatient Settings.Joint Commission journal on quality and patient safety · 2024Article
- Utilization of broad- versus narrow-spectrum antibiotics for the treatment of outpatient community-acquired pneumonia among adults in the United States.Pharmacoepidemiology and drug safety · 2024Article
- Healthcare Costs ofOpen forum infectious diseases · 2023Article
Corrections and comments
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundLittle 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.
methodsWe 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.
resultsAmong 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.
conclusionsInappropriate 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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Registered trials
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