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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. Almost half of elderly patients received an antibiotic prescription for a non-bacterial acute upper respiratory infection (AURI.

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2. Patients were more likely to receive prescriptions for non-bacterial AURI from physicians in mid- to late-stages of their careers, as well as those trained outside of Canada or the United States.

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Evidence Rating Level: 2 (Good)

Study Rundown:

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Antibiotic over prescription is a significant public health issue. Unnecessary antibiotic use can lead to adverse drug events, increased health care costs, and antibiotic resistance, among other challenges. One main area of concern involves the practice of unnecessarily prescribing antibiotics for non-bacterial ACUIs, such as the common cold. Despite guidelines encouraging judicious prescribing for patients with these conditions, many physicians continue to prescribe antibiotics at high rates. Considering this public health issue, the authors of this study aimed to determine the prevalence of antibiotic prescription for nonbacterial AURIs within a low risk elderly cohort. Additionally, they investigated whether prescribing rates differed among physician populations. Generally, they observed that antibiotic prescribing in their elderly patient cohort was high; almost half of patients were prescribed antibiotics for a non-bacterial AURI. This study has several limitations. First, the study did not capture physician rationale for prescribing due to its retrospective nature. Additionally, while the data sources are well validated, it is always important to note that diagnostic data obtained from physician billing claims may pose challenges regarding accuracy. Overall, the results of this study suggest that antibiotic over prescribing is a key issue within the elderly population. Furthermore, it better illuminates some of the physician predictors for antibiotic over prescribing.

In-Depth [retrospective cohort]:

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The authors conducted a retrospective cohort study of low risk older patients (>65 years) who presented to a primary care physician with a non-bacterial AURI between 1 January and 31 December 2012. The authors evaluated the prevalence of antibiotic over prescription, as well as the characteristics of physicians involved in this practice. In general, 46 per cent of patients received an antibiotic prescription, most of which were for broad-spectrum agents (69.6% [95% CI, 69.6% to 70.2%]). Additionally patients were more likely to be prescribed antibiotics from physicians in the mid- to late-stages of their careers compared to physicians early in their careers (rate difference, 5.1 percentage points [CI, 3.9 to 6.4 percentage points] and 4.6 percentage points [CI, 3.3 to 5.8 percentage points], respectively). Other factors related to over prescription included physicians trained outside of Canada and the United States, as well as those that saw a high volume of patients per day.

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