Reducing Antibiotic Use in the Management of Upper Respiratory Infections in the Urgent Care Setting

Purpose: Upper Respiratory Infections (URIs) are the most common presenting complaint to urgent care centers across the United States. Regardless of etiology or provider specialty, antibiotics are prescribed 60% of the time for the treatment of URIs, contributing to drug resistant respiratory organisms which often provide clinical management challenges for patients and their providers. These practices impact patient outcomes, quality of care, antimicrobial resistance, and economics in community and hospital settings. Chart reviews at a local urgent care company revealed similar practices among providers. Differences in provider type, knowledge base, confidence, practice experiences, and the lack of company adopted treatment guidelines were noted to be probable contributors. As a result, a quality improvement project was implemented to promote quality, evidenced based care in the management of patients with upper respiratory infections.

Methods: A multimodal intervention combining provider consensus meetings, clinical guideline review and development, use of clinical pathways, prescriber feedback and audit, and patient education was implemented at two urgent care centers to reduce the rate of antibiotic prescribing for URIs. Antibiotic prescribing rates for the baseline and intervention periods were obtained through the review of 273 patient charts with diagnoses of URI, nasopharyngitis, bronchitis, and sinusitis for each respective period and compared. Clinical guideline adherence rates were also captured and analyzed for this intervention.

Results: Evaluation of 273 patient encounters with diagnoses of URI, sinusitis and bronchitis during the intervention period demonstrated a 56.8% reduction in the prescribing rate of antibiotics (CI 95%, p <0.00) and an 87.2% rate of compliance with the adopted clinical guidelines (CI 95%, p < 0.00).

Conclusion: Antibiotic prescribing for common URI diagnoses was significantly reduced at two urgent care centers through the implementation of multimodal strategies targeting providers and patients. Such an approach could enhance compliance with URI evidence-based practice guidelines in the outpatient setting resulting in the judicious use of antibiotics.