Can implementation science help to overcome challenges in translating judicious antibiotic use into practice?

Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. Predictors of broad-spectrum antibiotic prescribing for acute respiratory tract infections in adult primary care. report, sub-task 2 (prepared by RTI International for the Centers for Medicare & Medicaid Services through an interagency agreement with the Agency for Health-care Research and Policy, under contract 500-00-0024, task 21). AHRQ publication 08-0029-EF. Using electronic health records to measure physician performance for acute conditions in primary care: empirical evaluation of the community-acquired pneumonia clinical quality measure set. Risk factors for 30-day mortality in elderly patients with lower respiratory tract infection: community-based study. I n this issue of the Archives, 2 national studies 1,2 provide distinct perspectives on the problem of antibiotic overuse in the United States. Fairlie et al 1 conducted a secondary analysis of National Ambulatory Medical Care Survey data covering a 10-year period to measure antibiotic prescription rates for the common condition of acute sinusitis. Zhang et al 2 analyzed Medicare Part D claims data for patients 65 years or older from 2007 through 2009 to assess geographic and seasonal variation in antibiotic prescriptions, considering prevalence patterns of common acute respiratory tract infections (ARIs) and various covariates. Both studies used appropriate methods and advanced statistical analyses to show that the overuse of antibiotics remains high and that variation in overuse is not fully explained by clinical factors available in these data sets. Studies such as these are important reminders that the United States still has a long way to go in reducing antibiotic overuse. In the context of past efforts to understand and improve antibiotic prescribing in the United States, the results from these 2 studies raise the question of why the problem of overprescribing persists. More than 15 years have elapsed since antibiotic overuse became a national priority, largely in response to the emergence of penicillin resistance to Streptococcus pneumoniae, a major threat to public health given its dominant role in severe community acquired infections, such as pneumonia, meningitis , and sepsis. 3,4 Beginning in 1995, studies 5-7 based on the National Ambulatory Medical Care Survey have shown that approximately 3 of every 4 antibiotic prescriptions in US ambulatory practices were for the treatment of ARIs, most of which have a viral origin. In the lay press, reports and stories related to antibiotic resistance (such as …