Our study found that in 2007 and 2008, macrolide was the most frequently prescribed antibiotic class (35%) and penicillins were prescribed to only about 5% of the visits. Because of the differences in inclusion/exclusion criteria among the studies,

the prescription prevalence rates are not directly comparable. However, it is evident that there Inhibitors,research,lifescience,medical have been changes in providers’ prescribing patterns. The over-prescribing of macrolide, mostly azithromycin, may be attributable to its availability, low cost and microbial coverage. About 10% of adult pharyngitis cases are caused by Group A Hemolytic Streptococcus (GABHS). The most common organisms that cause community-acquired pneumonia include Inhibitors,research,lifescience,medical Streptococcus pneumoniae and Mycoplasma penumoniae. These three organisms, if not resistant, are sensitive to azithromycin. With the overlap of the symptoms of community-acquired pneumonia and upper respiratory infections, the increased use of azithromycin may be

the result of diagnostic uncertainty and a shot-gun approach to treat the common respiratory symptoms seen in the EDs. Over time, many ED providers may have adopted this practice in treating the otherwise healthy patient population as a means to expedite patient disposition in response to increasing ED crowding and longer patient turn-over Inhibitors,research,lifescience,medical time. The prescribing of antibiotics may also be associated with providers’ attempt to increase patient satisfaction [10-14]. In a study of 5 urban teaching hospital EDs, more treatments SB505124 purchase received in EDs was associated with a higher level of patient satisfaction, even after controlling for other confounding factors [15], Inhibitors,research,lifescience,medical although another study failed to demonstrate this association [16]. The current study found that longer waiting time was associated

with prescribing antibiotics. This may have reflected ED providers’ Inhibitors,research,lifescience,medical efforts to prevent patient dissatisfaction rather than their propensity to prescribing antibiotics, for it was well demonstrated that waiting time in the EDs was a key predictor of patient satisfaction [15,17-20]. In addition, the current study found that almost half of the URI visits had imaging studies, particularly X-ray. Because we selected the healthiest age group without concurrent conditions first from the general ED patient population to construct the sample, such a high prevalence of the use would suggest overutilization of care. One of the key rationales for ordering imaging studies among patients with respiratory symptoms was to rule out pneumonia. The incidence of community acquired pneumonia among patients with respiratory symptoms was between 2.7% and 7% in the general population [21-24]. For adult 18–64years of age without comorbidities, the incidence rate should be much lower. The overuse of imaging raises the concern for radiation-linked cancers, longer visits, and higher visit cost.