Schroeck et al identified risk factors for inappropriate antibiotic therapy in patients presenting with an upper respiratory tract infection. The authors are from VA Western New York Healthcare System, University of Buffalo, Erie County Medical Center and East Orange VA.

Patient selection: adult with no significant comorbid condition ("otherwise healthy")


Outcome: noncompliance with the CDC Get Smart campaign


A patient was more likely to receive inappropriate therapy if:

(1) cough is the only symptom without sign of bacterial infection (simple bronchitis, nonspecific upper respiratory tract infection)

(2) the patient is seen in the Emergency Department or primary care

(3) the patient has a penicillin allergy


Therapy was usually considered appropriate if there was some indication of a bacterial infection:

(1) fever

(2) tonsillar exudate

(3) cervical lymphadenopathy

(4) positive laboratory test or imaging study indicative of a bacterial infection


A macrolide was the most frequently prescribed class of antibiotics with others including fluoroquinolone. penicllin or cephalosporin.

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