Prevalence and healthcare burden of inappropriate antimicrobial treatment in patients at high risk of complications from acute respiratory infections: a scoping review.

Background: Evidence of inappropriate antimicrobial treatment for acute respiratory infections (ARIs) is well-established in literature. However, comprehensive evaluations of inappropriate antimicrobial use and associated clinical and economic outcomes for patients at high risk of complications from ARIs are lacking. This scoping review described the prevalence of inappropriate antimicrobial use and its healthcare burden in this patient population. Materials and methods: We queried Medline and CINAHL databases using keywords related to antimicrobials for ARIs in high-risk patients, and included United States studies reporting prescribing patterns, outcomes, adverse events, and costs. Results: Our search yielded 3,383 studies after de-duplication, from which 482 were selected for full-text evaluation based on exclusion criteria, resulting in 32 papers analyzed that included relevant information on high-risk populations. The analysis suggested that patients at high risk for complications experience improper prescribing of antimicrobials for ARIs, which is associated with higher direct and indirect costs, increased health care resource utilization, higher incidence of adverse events, and more severe disease complications. Conclusion: Areas for improving care for this patient population include identifying patients at risk of severe disease and complications from ARIs and following evidence-based protocols for testing, treatment and follow-up to minimize the risk of developing adverse events, antibiotic-resistance, and severe complications.