ABSTRACT
Antibiotics are widely prescribed empirically for clinically diagnosed respiratory tract infections accounting for three-quarters of such community prescriptions. Tonsillopharyngitis is the most frequent indication followed by bronchitis, and most of the latter are prescribed to adult patients who are experiencing an exacerbation of chronic lung disease (1). An analysis of acute exacerbations of chronic obstructive pulmonary disease (COPD) in the United States illustrates the size of the problem (2). Using 1994 data to make their calculations, the survey estimated that there were 280,000 hospital admissions and 10 million outpatient visits primarily due to COPD. The majority of patients in both groups were 65 years or older, and older patients had a longer hospital stay. Most patients were given an antibiotic, so the volume prescribed for this indication was enormous. The average cost of a doctor’s office visit was estimate to be $74, whereas the average cost of a hospital admission was $5516. Antibiotics accounted for only a small proportion of the hospital costs. Therefore any effective therapy that reduces the need for hospitalization will be highly cost effective because of the large difference in the cost of care in the two settings.
