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Assistant Clinical Professor, Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco; Clinical Pharmacist, CHW Medical Foundation — MedClinic Medical Group, Sacramento, CA
Associate Clinical Professor, Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco; Pharmacy Utilization Manager, CHW Medical Foundation — MedClinic Medical Group
Clinical Information Analyst, CHW Medical Foundation — MedClinic Medical Group
Professor of Clinical Pharmacy, Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco
Reprints: B Joseph Guglielmo PharmD, Department of Clinical Pharmacy, School of Pharmacy, University of California, Box 0622, RM C-152, San Francisco, CA 94143-0622, FAX 415/476-6632, E-mail bjg{at}itsa.ucsf.edu
BACKGROUND: Intervention programs can reduce inappropriate antibiotic use for the treatment of acute bronchitis in a closed health maintenance organization model.
OBJECTIVE: To evaluate the impact of a pharmacy-based intervention program intended to reduce antibiotic use in the treatment of acute bronchitis in a community-based physician group model.
SUBJECTS: Adult and pediatric patients with an office or urgent care visit for acute bronchitis during the baseline and study periods were included in the study. The clinicians were primary care physicians, nurse practitioners, and physician assistants in a suburban community-based physician group setting.
METHODS: All patients treated for acute bronchitis from January 1 through June 30, 1998, were evaluated for initial receipt of antibiotics and use of clinic resources (office visits, additional antibiotics). From September through December of 1998, physicians were provided literature from the Centers for Disease Control and Prevention (CDC), cough and cold package inserts, and newsletters intended to educate the providers regarding the inappropriateness of antibiotics in the treatment of acute bronchitis. Patient-directed literature from the CDC was placed in the examination rooms and clinic waiting areas beginning September 1998. From January 1 through June 30, 1999, all patients treated for acute bronchitis were assessed for receipt of antibiotics and use of clinic resources. A separate geographic clinic site served as a control during both study periods.
RESULTS: During 1998, 888 of 1840 patients (48.3%)
received antibiotics for treatment of acute bronchitis; this total decreased
to 924 of 2392 (38.6%; p 
0.001) in 1999, a reduction of 20%. The rate of
antibiotic prescribing in control patients was unchanged during the
concomitant time periods (142/446, 31.8% vs. 102/321, 31.8%). The rate of
subsequent physician visits was similar (8% vs. 9%) between patients receiving
antibiotics and those who did not. However, significantly more patients
initially receiving antibiotics required a subsequent antibiotic prescription
(45/1812, 2.5% vs. 24/2420, 1.0%; p 0.001).
CONCLUSIONS: A pharmacy-based intervention program reduces the incidence of inappropriate antibiotic use in the treatment of acute bronchitis. Reduced antibiotic prescribing does not increase consumption of healthcare resources; patients who receive antibiotics for acute bronchitis are more likely to subsequently require additional antibiotic prescriptions. While a significant decrease in antibiotic use was realized, other interventions are required to further reduce the prevalence of antibiotic use in acute bronchitis.
Key Words: acute bronchitis, community-based physician group model, inappropriate antibiotic use
Published Online, January 9, 2003. www.theannals.com, DOI
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  J. M Thorpe, S. R Smith, and T. K Trygstad Trends in Emergency Department Antibiotic Prescribing for Acute Respiratory Tract Infections Ann. Pharmacother., June 1, 2004; 38(6): 928 - 935. [Abstract] [Full Text] [PDF]
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