July 28, 2009

Dear Peach State Health Plan Provider:

 
As children return to school, the number of upper respiratory tract infections (URTIs) increases. Peach State wants to provide you, our providers, with information regarding treatment of these infections. 

URTIs are very common among adults and children. In fact, these illnesses are the most frequent cause of utilizing medical care in the United States and, not surprisingly, drive about 75% of all antibiotic prescriptions written each year. While URTIs represent a broad range of disorders, including the common cold, otitis media, bronchitis, pharyngitis, pneumonia, and sinusitis, it is important for the clinician to treat these conditions appropriately.¹ The Healthcare Effectiveness Data and Information Set (HEDIS) measures and evaluates patients who were given a diagnosis of URTI only and were not given an antibiotic prescription. A higher rate indicates appropriate treatment of an URTI, or a greater proportion of patients who were not given antibiotics.

It is necessary for physicians to be prudent in their prescribing habits to treat URTIs, due to the growing resistance to antimicrobials. Streptococcus pneumonia, the common causative agent of bacterial meningitis, bacterial pneumonia, bacterial sinusitis and otitis media, has gained increased antibiotic resistance in the past several years. Recent antibiotic exposure is one of the most significant predictors of antibiotic resistance.¹  The causative agent of upper respiratory symptoms, such as cough, rhinorrhea, sinus pain, and/or a sore throat can be bacterial, but more often these symptoms can be attributed to a virus. Antibiotics are ineffective in treating viral infections. ¹

Inappropriate treatment of URTIs may contribute to antibiotic resistance, but can
also lead to adverse drug events (including allergies) and drug-drug interactions. Inappropriate use of antibiotics will often lead to unnecessary increased medical costs. ¹ Many clinicians are concerned that patients will not be satisfied with their care if they do not receive an antibiotic prescription for upper respiratory tract symptoms. However, in a study published in the Journal of Family Practice, patients found the quality of the interaction with their clinician to be more important than being prescribed an antibiotic.² Appropriate treatment and assessment of URTIs is an important piece of medical practice. URTIs are very frequent in the United States and inappropriate treatment can lead to increased healthcare costs, adverse drug events, drug to drug interactions and increased antimicrobial resistance; therefore, it is important to reserve antibiotic use for patients in which they are absolutely necessary.

 References

1.  Gonzales, R. MD, MSPH; Bartlett, J. MD; Besser, R. MD; et al. Principles of
Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in
Adults: Background, Specific Aims, and Methods. Ann of Intern Med. 2001; 134: 479-486.
2.  Hamm, R, Hicks, R, Bemden, D. antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Pract. 1996; 43: 56-62.

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