Trends in antibiotic prescribing for acute respiratory infection in veterans with spinal cord injury and disorder

Objectives: Most acute respiratory infections (ARIs) are viral and do not warrant antibiotic therapy. Studies to date have not examined trends in antibiotic use in ARIs in populations with disabilities, thus we assessed antibiotic prescribing for veterans with spinal cord injury and disorder (SCI&D) with outpatient ARI visits. Patients and methods: Retrospective study using Department of Veterans Affairs (VA) administrative and pharmacy datasets (1 October 1998-30 September 2001; fiscal years 1999-2001) to assess antibiotic prescribing for upper respiratory infection (URI), lower respiratory infection (LRI), and pneumonia in veterans with SCI&D. Results: There were 5713 ARI visits; 50% received new antibiotic prescriptions. URI and LRI visits were 2.3 times and almost 4 times (P < 0.0001), respectively, more likely to have antibiotics prescribed than pneumonia visits. The majority of URI visits with antibiotic prescriptions had a diagnosis of the common cold or URI not otherwise specified (78%). Acute bronchitis without exacerbation was associated with 95% of LRI visits that received antibiotics. Broad-spectrum antibiotic use increased over time (1999, 46%; 2001, 62%; P < 0.0001). Conclusions: Although rates of antibiotic prescribing remained stable, prescriptions for broad-spectrum antibiotics increased. Most prescriptions were for indications for which antibiotic use is generally not recommended. Since patients with SCI&D are susceptible to multiple complications, providers may be more concerned with ensuring that any infection is treated, rather than the potential for overuse and resistance. Future efforts should focus on defining benefits of antibiotic use for ARIs in those with disabilities, predictors of prescribing, and interventions to prevent injudicious use of antibiotics.