Use of antibiotics for adult upper respiratory infections in outpatient settings: a national ambulatory network study

Fam Med. 2006 May;38(5):349-54.


Background and objectives: Studies have suggested that antibiotics are often inappropriately used in the treatment of acute upper respiratory tract infections (URIs). This study examined antibiotic use for adult URIs in a large national network of offices that use electronic health records (EHRs).

Methods: Using the Medical Quality Improvement Consortium (MQIC) database, URI episodes were identified for patients ages 18 to 65 years from January 1, 1998, to March 31, 2003. The percentage of episodes for which antibiotics were prescribed and the proportion of antibiotics that were broad spectrum were calculated.

Results: Of the 52,135 URI episodes identified, 65% received antibiotics. Antibiotics were prescribed for 78% of acute bronchitis episodes, 65% of acute pharyngitis episodes, 81% of acute sinusitis episodes, and 33% of nonspecific URI episodes. The proportion of antibiotics that were broad spectrum was 56% for all URI episodes, 68% for acute bronchitis, 55% for acute sinusitis and nonspecific URI, and 40% for pharyngitis.

Conclusions: This study demonstrates overuse of antibiotics for adult URIs in a large national ambulatory care network, with particular overuse of broad-spectrum antibiotics. The study also illustrates the enormous potential of EHR data for conducting practice-based research across large national office networks.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Ambulatory Care*
  • Anti-Bacterial Agents / therapeutic use*
  • Cohort Studies
  • Drug Prescriptions
  • Female
  • Guidelines as Topic
  • Humans
  • Male
  • Medical Records Systems, Computerized
  • Middle Aged
  • Respiratory Tract Infections / drug therapy*
  • Retrospective Studies
  • United States


  • Anti-Bacterial Agents