Antibiotic Treatment for Lower Respiratory Tract Infections in Primary Care: A Register-Based Study Examining the Role of Radiographic Imaging

• Published in: Antibiotics (Basel) 2023-07, Vol.12 (7), p.1165
• Main Authors: Carlsson, Sara, Hedin, Katarina, Cronberg, Olof, Moberg, Anna
• Format: Article
• Language: English
• Subjects: acute bronchitis; Age; Allmänmedicin; Antibiotics; Antimicrobial agents; Asthma; Bacterial pneumonia; Bronchitis; C-reactive protein; Cardiovascular disease; Care and treatment; characteristics; Chest; chest imaging; Chronic obstructive pulmonary disease; Clinical Medicine; Computed tomography; CT imaging; Drug resistance; Electronic health records; Electronic medical records; Family Medicine; Health aspects; Infections; Ischemia; Klinisk medicin; lower respiratory tract infections; Medical and Health Sciences; Medical imaging; Medical records; Medical research; Medicin och hälsovetenskap; Medicine, Experimental; Morbidity; Patients; Physicians; Pneumonia; Prescription writing; Prescriptions; Primary care; Respiratory tract; Respiratory tract diseases; Respiratory tract infection
• ISSN: 2079-6382; 2079-6382
• DOI: 10.3390/antibiotics12071165

When imaging (i.e., chest-x-ray or computed tomography) is used to differentiate between acute bronchitis and pneumonia, many patients are being prescribed antibiotics despite the absence of radiographic pneumonia signs. This study of lower respiratory tract infections (LRTIs) with negative chest imaging compares cases where antibiotics were prescribed and not prescribed to find characteristics that could explain the prescription. Data were extracted from the regional electronic medical record system in Kronoberg County, Sweden, for patients aged 18-79 years diagnosed with acute bronchitis or pneumonia and who had any chest radiologic imaging between 2007-2014. Of 696 cases without evidence of pneumonia on imaging, 55% were prescribed antibiotics. Age, sex, and co-morbidity did not differ between those with or without antibiotics. The median level of C-reactive protein was low in both groups but differed significantly (21 vs. 10 mg/L; < 0.001). Resident physicians prescribed antibiotics more frequently than interns or specialists ( < 0.001). It is unclear what features prompted the antibiotic prescribing in those with negative imaging indicating overuse of antibiotics for LRTIs.