Acute respiratory tract infection (ARTI), which includes
acute uncomplicated bronchitis, pharyngitis,
rhinosinusitis, and the common cold, is the most
common reason for acute outpatient physician office
visits and antibiotic prescription in adults. Antibiotics
are prescribed at more than 100 million adult ambulatory
care visits annually, and 41% of these prescriptions
are for respiratory conditions (1). Inappropriate antibiotic
use for ARTI is an important contributor to antibiotic
resistance, an urgent public health threat (2). In
the United States, at least 2 million antibiotic-resistant
illnesses and 23 000 deaths occur each year, at a cost
to the U.S. economy of at least $30 billion (2). Increased
community use of antibiotics is highly correlated with
emerging antibiotic-resistant infections. In places with
greater prescribing of broad-spectrum antibiotics, specifically
extended-spectrum cephalosporins and macrolides,
rates of multidrug-resistant pneumococcal disease
are higher (3).
Antibiotics are also responsible for the largest
number of medication-related adverse events, implicated
in 1 of every 5 visits to emergency departments
for adverse drug reactions (4). Adverse events range in
severity from mild (for example, diarrhea and rash) to
life-threatening (for example, Stevens–Johnson syndrome,
anaphylaxis, or sudden cardiac death). Although
data on adverse events after inappropriate antibiotic
use are not available, an estimated 5% to 25%
of patients who use antibiotics have adverse events,
and about 1 in 1000 has a serious adverse event (2).
Clostridium difficile diarrhea, which can be lifethreatening
and is usually a result of antibiotic treatment,
causes nearly 500 000 infections and 29 300
deaths in the United States each year, leading to an
estimated $1 billion in extra medical costs (5).