Percentage of children 3 months-18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days after the episode.

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In 1998, 25 million patients (adults and children) sought care for non-specific upper respiratory infections (URI, also known as the common cold) and 30 percent received antibiotics (Gonzales 2001). 
 
Inappropriate antibiotic prescriptions for URI, pharyngitis and bronchitis are estimated to amount to 55 percent (22.6 million) of all antibiotics prescribed for acute respiratory infections, costing $726 million in 1998 (Gonzales 2001).
 
Using antibiotics inappropriately can lead to antibiotic resistance, which can result in increased morbidity and mortality (Feikin 2000). The resulting increased effort to treat drug-resistant pathogens can also lead to more repeated health care visits, greater risk of disease complications and increased health care costs (Feikin 2000; Dagan 2000; Watanabe 2000).

American Family Physician (Wong, Blumberg, and Lowe 2006) 

- A diagnosis of acute bacterial rhinosinusitis should be considered in patients with symptoms of a viral upper respiratory infection that have not improved after 10 days or that worsen after five to seven days. (C) 

- Treatment of sinus infection with antibiotics in the first week of symptoms is not recommended. (C)

- Telling patients not to fill an antibiotic prescription unless symptoms worsen or fail to improve after several days can reduce the inappropriate use of antibiotics. (B)

Higher scores indicates better quality

Wong, D.M., D.A. Blumberg, and L.G. Lowe. 2006. “Guidelines for the use of antibiotics in acute upper respiratory tract infections.” Am Fam Physician 74(6):956-966.

Dagan, R. 2000. “Clinical significance of resistant organisms in otitis media.” Pediatr Infect Dis J 19(4):378-382.

Feikin, D.R., A. Schuchat, M. Kolczak, N.L. Barrett, L.H. Harrison, L. Lefkowitz, A. McGeer, M.M. Farley, D.J. Vugia, C. Lexau, K.R. Stefonek, J.E. Patterson, J.H. Jorgensen. 2000. “Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997.” Am J Public Health 90(2):223-229.

Gonzales, R., D.C. Malone, J.H. Maselli, M.A. Sande. 2001. “Excessive antibiotic use for acute respiratory infections in the United States.” Clin Infect Dis 33(6):757-762.

Watanabe, H., S. Sato, K. Kawakami, K. Watanabe, K. Oishi, N. Rikitomi, T. li, H. Ikeda, A. Sato, T. Nagatake. 2000. “A comparative clinical study of pneumonia by penicillin-resistant and sensitive Streptococcus pneumoniae in a community hospital.” Respirology 5(1):59-64.

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This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. If the patient has more than one episode, include all episodes in the measure.

TBD

Children age 3 months to 18 years who had an outpatient or emergency department (ED) visit with a diagnosis of upper respiratory infection (URI) during the measurement period

Equals Initial Patient Population

Exclude children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established. Exclude children who had an encounter with a competing diagnosis within three days after the initial diagnosis of URI.

Children without a prescription for antibiotic medication on or 3 days after the outpatient or ED visit for an upper respiratory infection

Not Applicable

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Not Applicable

Not Applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.