{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T16:04:28Z","timestamp":1788883468059,"version":"build-2803163510"},"reference-count":60,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T00:00:00Z","timestamp":1667952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000875","name":"The Pew Charitable Trusts","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000875","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2 TR002346"],"award-info":[{"award-number":["KL2 TR002346"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007930","name":"Institute of Clinical and Translational Sciences","doi-asserted-by":"publisher","award":["UL1 TR002345"],"award-info":[{"award-number":["UL1 TR002345"]}],"id":[{"id":"10.13039\/100007930","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["KL2 TR002346"],"award-info":[{"award-number":["KL2 TR002346"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R24 HS19455"],"award-info":[{"award-number":["R24 HS19455"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007268","name":"Washington University in St. Louis","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007268","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Little is known about the clinical and financial consequences of inappropriate antibiotics. We aimed to estimate the comparative risk of adverse drug events and attributable healthcare expenditures associated with inappropriate versus appropriate antibiotic prescriptions for common respiratory infections.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We established a cohort of adults aged 18 to 64 years with an outpatient diagnosis of a bacterial (pharyngitis, sinusitis) or viral respiratory infection (influenza, viral upper respiratory infection, nonsuppurative otitis media, bronchitis) from 1 April 2016 to 30 September 2018 using Merative MarketScan Commercial Database. The exposure was an inappropriate versus appropriate oral antibiotic (ie, non-guideline-recommended vs guideline-recommended antibiotic for bacterial infections; any vs no antibiotic for viral infections). Propensity score-weighted Cox proportional hazards models were used to estimate the association between inappropriate antibiotics and adverse drug events. Two-part models were used to calculate 30-day all-cause attributable healthcare expenditures by infection type.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 3 294 598 eligible adults, 43% to 56% received inappropriate antibiotics for bacterial and 7% to 66% for viral infections. Inappropriate antibiotics were associated with increased risk of several adverse drug events, including Clostridioides difficile infection and nausea\/vomiting\/abdominal pain (hazard ratio, 2.90; 95% confidence interval, 1.31\u20136.41 and hazard ratio, 1.10; 95% confidence interval, 1.03\u20131.18, respectively, for pharyngitis). Thirty-day attributable healthcare expenditures were higher among adults who received inappropriate antibiotics for bacterial infections ($18\u2013$67) and variable (\u2212$53 to $49) for viral infections.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Inappropriate antibiotic prescriptions for respiratory infections were associated with increased risks of patient harm and higher healthcare expenditures, justifying a further call to action to implement outpatient antibiotic stewardship programs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciac879","type":"journal-article","created":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T15:00:04Z","timestamp":1668006004000},"page":"986-995","source":"Crossref","is-referenced-by-count":27,"title":["Comparative Safety and Attributable Healthcare Expenditures Following Inappropriate Versus Appropriate Outpatient Antibiotic Prescriptions Among Adults With Upper Respiratory Infections"],"prefix":"10.1093","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7307-6864","authenticated-orcid":false,"given":"Anne M","family":"Butler","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine , St. Louis, Missouri , USA"},{"name":"Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine , St. Louis, Missouri , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek S","family":"Brown","sequence":"additional","affiliation":[{"name":"Brown School, Washington University , St. Louis, Missouri , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason G","family":"Newland","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University School of Medicine, St. Louis , St. Louis, Missouri , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4116-512X","authenticated-orcid":false,"given":"Katelin B","family":"Nickel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine , St. Louis, Missouri , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M","family":"Sahrmann","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine , St. Louis, Missouri , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline A","family":"O\u2019Neil","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine , St. Louis, Missouri , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret A","family":"Olsen","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine , St. Louis, Missouri , USA"},{"name":"Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine , St. Louis, Missouri , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9795-2603","authenticated-orcid":false,"given":"Rachel M","family":"Zetts","sequence":"additional","affiliation":[{"name":"The Pew Charitable Trusts , Washington, DC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Y","family":"Hyun","sequence":"additional","affiliation":[{"name":"The Pew Charitable Trusts , Washington, DC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Durkin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine , St. Louis, Missouri , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,11,9]]},"reference":[{"key":"2023052918401949500_ciac879-B1","volume-title":"Antibiotic use in outpatient settings. 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