Table 2. Antibiotic Prescribing by Diagnostic Category Tier Among Patients With Acute Respiratory Infections in the 2013-2014 and 2014-2015 Influenza Seasons at Ambulatory Care Settings Affiliated With the US Influenza Vaccine Effectiveness Networka.
| Diagnosis | Patients, No. (%) | |||||
|---|---|---|---|---|---|---|
| All Ages | Pediatric | Adult | ||||
| Total (N = 14 987)b | Prescribed Antibiotic (n = 6136)c | Total (n = 5700)b | Prescribed Antibiotic (n = 2173)c | Total (n = 9287)b | Prescribed Antibiotic (n = 3963)c | |
| Tier 1: antibiotics almost always indicated | 467 (3) | 416 (89) | 218 (4) | 187 (86) | 249 (3) | 229 (92) |
| Pneumonia | 447 (3) | 400 (89) | 202 (4) | 174 (86) | 245 (3) | 226 (92) |
| Miscellaneous bacterial infections | 20 (0.1) | 16 (80) | 16 (0.3) | 13 (81) | 4 (0.04) | 3 (75) |
| Tier 2: antibiotics potentially indicatedd | 5129 (34) | 3198 (62) | 2322 (41) | 1445 (62) | 2807 (30) | 1753 (62) |
| Pharyngitis | 2494 (17) | 1000 (40) | 1167 (20) | 439 (38) | 1327 (14) | 561 (42) |
| Sinusitis | 1707 (11) | 1385 (81) | 243 (4) | 192 (79) | 1464 (16) | 1193 (81) |
| Suppurative otitis media | 1212 (8) | 1055 (87) | 993 (17) | 881 (89) | 219 (2) | 174 (79) |
| Tier 3: antibiotics not indicatede | 9391 (63) | 2522 (27) | 3160 (55) | 541 (17) | 6231 (67) | 1981 (32) |
| Viral upper respiratory tract infection | 5553 (37) | 1376 (25) | 1964 (34) | 299 (15) | 3589 (39) | 1077 (30) |
| Bronchitisf | 1157 (8) | 730 (63) | 107 (2) | 74 (7) | 1050 (11) | 656 (62) |
| Allergy or asthma | 1217 (8) | 289 (24) | 451 (8) | 61 (14) | 766 (8) | 228 (30) |
| Influenza diagnosis codeg | 1257 (8) | 167 (13) | 317 (6) | 43 (14) | 940 (10) | 124 (13) |
| Viral pneumonia | 3 (0.02) | 2 (67) | 2 (0.04) | 1 (50) | 1 (0.01) | 0 |
| Remaining codes not listed elsewhere | 1463 (10) | 373 (25) | 602 (11) | 113 (19) | 861 (9) | 260 (30) |
The diagnostic category tiers are adapted from Fleming-Dutra et al2 and Shapiro et al.14 The first 4 International Classification of Diseases, Ninth Revision diagnostic codes were examined. Each patient was classified in a tier; priority was given to tier 1 diagnoses, then tier 2 diagnoses, then tier 3 diagnoses. However, individuals could be in more than 1 diagnosis category.
Percentage indicates the percentage in the column.
Percentage indicates the percentage in the row.
Excludes patients with any tier 1 diagnosis.
Excludes patients with any tier 1 or tier 2 diagnosis.
Excludes 31 adults with a history of chronic obstructive pulmonary disease per medical record or who had a chronic obstructive pulmonary disease diagnosis code. If these are included, 684 of 1081 adults (63%) with a diagnosis of bronchitis received antibiotics.
Indicates an International Classification of Diseases, Ninth Revision code diagnosis of influenza, not laboratory confirmation of influenza, which was performed for research purposes only.