Original Investigation Infectious Diseases June 8, 2018 Outpatient Antibiotic Prescribing for Acute Respiratory Infections During Influenza Seasons Fiona P. Havers, MD1; Lauri A. Hicks, DO1; Jessie R. Chung, MPH1; Manjusha Gaglani, MD2; Kempapura Murthy, MPH2; Richard K. Zimmerman, MD3; Lisa A. Jackson, MD4; Joshua G. Petrie, PhD5; Huong Q. McLean, PhD6; Mary Patricia Nowalk, PhD3; Michael L. Jackson, PhD4; Arnold S. Monto, MD5; Edward A. Belongia, MD6; Brendan Flannery, PhD1; Alicia M. Fry, MD1 Article Information JAMA Netw Open. 2018;1(2):e180243. doi:10.1001/jamanetworkopen.2018.0243 Key Points Question What are targets for improving antibiotic stewardship for outpatient acute respiratory infections? Findings Among 14 987 outpatients with acute respiratory infections enrolled in this cohort study during influenza seasons, 41% were prescribed antibiotics, 41% of whom had diagnoses for which antibiotics are not indicated, primarily viral upper respiratory tract infections and bronchitis; 29% of patients with influenza confirmed through research testing were prescribed antibiotics. Among patients prescribed antibiotics, 38% with pharyngitis tested negative for group A streptococcus and 38% with sinusitis had symptoms for 3 days or less before the visit, suggesting antibiotic therapy was not required. Meaning Eliminating antibiotic treatment of viral upper respiratory tract infections and bronchitis, improving influenza diagnosis and treatment, and reinforcing prescription guidelines for pharyngitis and sinusitis could improve outpatient antibiotic stewardship. Abstract Importance Acute respiratory infections (ARIs) are the syndrome for which antibiotics are most commonly prescribed; viruses for which antibiotics are ineffective cause most ARIs. Objectives To characterize antibiotic prescribing among outpatients with ARI during influenza season and to identify targets for reducing inappropriate antibiotic prescribing for common ARI diagnoses, including among outpatients with laboratory-confirmed influenza. Design, Setting, and Participants Cohort study enrolling outpatients aged 6 months or older with ARI evaluated at outpatient clinics associated with 5 US Influenza Vaccine Effectiveness Network sites during the 2013-2014 and 2014-2015 influenza seasons. All patients received influenza testing by real-time reverse transcriptase–polymerase chain reaction for research purposes only. Antibiotic prescriptions, medical history, and International Classification of Diseases, Ninth Revision diagnosis codes were collected from medical and pharmacy records, as were group A streptococcal (GAS) testing results in a patient subset.