In the United States, overprescribing of antibiotics for viral respiratory infections and antimicrobial resistance continue to be public health concerns. To date, no literature has focused on antibiotic prescribing patterns from free clinics. To address this gap, we used patient-level data from a student-run free clinic network of four primary care clinics to assess factors associated with inappropriate antibiotic prescribing for viral respiratory infections. Treatment plans were deemed inappropriate if any type of antibiotic was prescribed. We used unpaired t tests and chi-square tests to assess for differences in receiving an inappropriate antibiotic prescription by patient-level factors (i.e. age, race/ethnicity, sex, educational attainment, preferred language, insurance status). Of 298 visits, 22.5% did not meet treatment guidelines. No patient-level factors studied were associated with inappropriate antibiotic prescribing. Our findings suggest other factors, beyond those at the patient level, may be drivers of variation in antibiotic prescribing in free clinics.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Spellberg B, Guidos R, Gilbert D, et al. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis. 2008;46:155–64.
Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol. 2012;33:322–7.
Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States: 2019 [Internet]. Available from: https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf. Accessed 25 Mar 2021.
Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013 [Internet]. Available from: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf. Accessed 26 Mar 2021.
Shehab N, Patel PR, Srinivasan A, et al. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis. 2008;47:735–43.
Carmeli Y, Eliopoulos G, Mozaffari E, et al. Health and economic outcomes of vancomycin-resistant enterococci. Arch Intern Med. 2002;162:2223–8.
Patel G, Huprikar S, Factor SH, et al. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol. 2008;29:1099–106.
Borer A, Saidel-Odes L, Riesenberg K, et al. Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia. Infect Control Hosp Epidemiol. 2009;30:972–6.
Mauldin PD, Salgado CD, Hansen IS, et al. Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic-resistant gram-negative bacteria. Antimicrob Agents Chemother. 2010;54:109–15.
Cosgrove SE, Qi Y, Kaye KS, et al. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol. 2005;26:166–74.
Spellberg B, Powers JH, Brass EP, et al. Trends in antimicrobial drug development: implications for the future. Clin Infect Dis. 2004;38:1279–86.
Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2017;2:CD003543.
Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev. 2005;CD003539.
Shively NR, Buehrle DJ, Clancy CJ, et al. Prevalence of inappropriate antibiotic prescribing in primary care clinics within a veterans affairs health care system. Antimicrob Agents Chemother. 2018;62(8):e00337-e418.
Shapiro DJ, Hicks LA, Pavia AT, et al. Antibiotic prescribing for adults in ambulatory care in the USA, 2007–09. J Antimicrob Chemother. 2014;69:234–40.
Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA. 2016;315:1864–73.
Finley CR, Chan DS, Garrison S, et al. What are the most common conditions in primary care? Systematic review. Can Fam Physician. 2018;64:832–40.
Binns HJ, Lanier D, Pace WD, et al. Describing primary care encounters: the primary care network survey and the national ambulatory medical care survey. Ann Fam Med. 2007;5:39–47.
Gerber JS, Prasad PA, Russell Localio A, et al. Variation in antibiotic prescribing across a pediatric primary care network. J Pediatr Infect Dis Soc. 2015;4:297–304.
Jones BE, Sauer B, Jones MM, et al. Variation in outpatient antibiotic prescribing for acute respiratory infections in the veteran population: a cross-sectional study. Ann Intern Med. 2015;163:73–80.
Shaver AL, Jacobs DM, LaMonte MJ, et al. Antibiotic prescribing for acute respiratory tract infections in the United States outpatient setting. BMC Fam Pract. 2019;20:91.
Barnett ML, Linder JA. Antibiotic prescribing for adults with acute bronchitis in the United States, 1996–2010. JAMA. 2014;311:2020–2.
Steinman MA, Gonzales R, Linder JA, et al. Changing use of antibiotics in community-based outpatient practice, 1991–1999. Ann Intern Med. 2003;138:525–33.
Fairlie T, Shapiro DJ, Hersh AL, et al. National trends in visit rates and antibiotic prescribing for adults with acute sinusitis. Arch Intern Med. 2012;172:1513–4.
Grijalva CG, Nuorti JP, Griffin MR. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA. 2009;302:758–66.
Shi L, Singh DA. Populations with special health needs. In: Shi L, Singh DA, editors. Essentials of the US health care system. Burlington: Jones & Bartlett Learning; 2017. p. 241–60.
Aday LA. Health status of vulnerable populations. Annu Rev Public Health. 1994;15:487–509.
Freeman HE, Blendon RJ, Aiken LH, et al. Americans report on their access to health care. Health Aff. 1987;6:6–8.
Ayanian JZ, Zaslavsky AM, Weissman JS, et al. Undiagnosed hypertension and hypercholesterolemia among uninsured and insured adults in the Third National Health and Nutrition Examination Survey. Am J Public Health. 2003;93:2051–4.
Ayanian JZ, Kohler BA, Abe T, et al. The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med. 1993;329:326–31.
Beckles GL, Engelgau MM, Narayan KM, et al. Population-based assessment of the level of care among adults with diabetes in the U.S. Diabetes Care. 1998;21:1432–8.
Institute of Medicine. Insuring America’s health: principles and recommendations. Washington, DC: The National Academies Press; 2004.
Darnell JS. Free clinics in the United States: a nationwide survey. Arch Intern Med. 2010;170:946–53.
Centers for Disease Control and Prevention. Antibiotic prescribing and use in doctor’s offices: Adult treatment recommendations [Internet]. Available from: https://www.cdc.gov/antibiotic-use/community/for-hcp/outpatient-hcp/adult-treatment-rec.html#ref8. Accessed 11 Dec 2020.
Snow V, Mottur-Pilson C, Gonzales R, American Academy of Family Physicians, American College of Physicians-American Society of Internal Medicine, Centers for Disease Control, et al. Principles of appropriate antibiotic use for treatment of acute bronchitis in adults. Ann Intern Med. 2001;134:518–20.
Smith SM, Fahey T, Smucny J, et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2014;CD000245.
Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006;129:1S-23S.
Gonzales R, Bartlett JG, Besser RE, et al. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann Intern Med. 2001;134:521–9.
Aggarwal R, Ranganathan P. Common pitfalls in statistical analysis: the use of correlation techniques. Perspect Clin Res. 2016;7:187–90.
Simpson SA, Long JA. Medical student-run health clinics: important contributors to patient care and medical education. J Gen Intern Med. 2007;22:352–6.
Walsh TL, Taffe K, Sacca N, et al. Risk factors for unnecessary antibiotic prescribing for acute respiratory tract infections in primary care. Mayo Clin Proc Innov Qual Outcomes. 2020;4:31–9.
Steinke DT, Bain DJ, MacDonald TM, et al. Practice factors that influence antibiotic prescribing in general practice in Tayside. J Antimicrob Chemother. 2000;46:509–12.
Courtenay M, Carter S, Rowbotham S, et al. Antibiotic prescribing in primary care: the need for interprofessional collaboration. J Interprof Care. 2015;29:404–5.
We would like to thank the peer reviewers for providing suggestions to strengthen the reporting of this article.
Research reported in this publication was supported by the University of Florida Clinical and Translational Science Institute, which is supported in part by the National Institutes of Health (NIH) National Center for Advancing Translational Sciences under award number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. University of Florida clinical and translational science institute
Conflict of interest
The authors declare no competing interests.
The University of Florida’s Institutional Review Board approved the protocol (IRB202002817).
Consent to participate
The protocol was approved with a waiver for participant consent due to the use of retrospective data originally collected for the purposes of treatment and clinical operations.
Consent for publication
To comply with ethics approval, we used a de-identified dataset and our reporting of this manuscript contains no identifiable information on participants.
Availability of data, code, and material
Available upon request to the corresponding author.
This work represents the original research of the authors. This work has not been previously published. AD, OTN, EM, AF, TH, and AG conceptualized the study. OTN analyzed the data. All authors interpreted the data. AD, OTN, and EM drafted the manuscript. All authors provided critical revisions to the manuscript. All authors approved the submission.
About this article
Cite this article
Daga, A., Nguyen, O.T., Moothedan, E. et al. Antibiotic prescribing patterns for acute respiratory infections in a free clinic network: a pooled cross-sectional study. Drugs Ther Perspect 38, 51–55 (2022). https://doi.org/10.1007/s40267-021-00883-6