Winter months see more antibiotic prescriptions for respiratory infections

Key takeaways:

• Antibiotic prescriptions occurred in 40.2% and 30.4% of visits for respiratory tract infections in winter and summer, respectively.
• One reason for the increase could be what researchers called ‘decision fatigue.’

Researchers observed an increase in antibiotic prescribing for respiratory tract infections in winter vs. summer months — likely driven in part by inappropriate prescribing.

“Seasonal fluctuations in prescribing have been demonstrated with wintertime peaks and summertime nadirs for certain diagnoses, including for [respiratory tract diagnoses (RTDs)]” Lacey Serletti, MD, a second-year resident in the department of medicine at the University of Pennsylvania Perelman School of Medicine, and colleagues wrote in Antimicrobial Stewardship & Healthcare Epidemiology.

They added that because increases in antibiotic prescribing drive drug resistance, “understanding of seasonal prescribing patterns is vital to antibiotic stewardship efforts broadly.”

The researchers evaluated 89,627 RTD visits at 32 primary care practices in the Penn Medicine Health System from July 1, 2016, to June 30, 2017.

RTDs were broken down into tiers that determined the likelihood of antibiotic prescriptions. These included:

• tier 1, where antibiotics were almost always indicated;
• tier 2, where antibiotics were sometimes indicated; and
• tier 3, where antibiotics were rarely indicated.

According to the researchers, 43% and 57% of RTD visits occurred in the summer and winter months, respectively.

They found that, overall, a greater proportion of RTD visits in the winter had an antibiotic prescription than those in the summer (40.2% vs. 30.4%).

A higher proportion of winter visits was associated with tier 2 RTDs compared with that of summer visits (29.4% vs. 23.4%), and a lower proportion of winter visits were associated with tier 3 RTDs (68.4% vs. 74.4%). However, the researchers found a greater proportion of visits in winter months had an antibiotic prescribed for both tier 2 RTDs (80.2% vs. 74.2%) and tier 3 RTDs (22.9% vs. 16.2%) — “specifically for sinusitis, otitis media, and ‘other RTDs,’ which included nonspecific respiratory symptoms such as cough and rhinorrhea and nonspecific diagnoses such as viral upper respiratory tract infection.”

The proportion of inappropriate antibiotic prescribing was 72.4% in the winter months and 62% in the summer months.

One potential explanation for the rise in inappropriate prescribing is what Serletti and colleagues called “decision fatigue” — “the phenomenon where a person’s ability to make decisions declines in quality after a long period of decision-making.”

“As visits for RTDs increase in winter months and clinicians must make more decisions about prescribing antibiotics, the quality of these decisions may deteriorate over time,” they wrote. “Decision fatigue may be exacerbated by emotional exhaustion arising from countering patient demand for unnecessary antibiotics.”

Moreover, patients may be more likely to ask for antibiotics in winter months, increasing pressure to prescribe them, they said.

Serletti and colleagues concluded that future studies are needed “to investigate the language around patients’ descriptions of symptoms, suggested diagnoses, or requests for antibiotics.”