# Antibacterial prescribing for acute upper respiratory infections in outpatients in Finland, 2017–2021: a Finnish registry study

## TL;DR

This study examines how often antibiotics are prescribed for viral upper respiratory infections in Finland, finding a decline in inappropriate prescriptions over time.

## Contribution

The study provides updated data on antibiotic prescribing trends for acute upper respiratory infections in Finland from 2017 to 2021.

## Key findings

- 9% of outpatient AURI diagnoses were prescribed antibacterials, most of which are viral.
- Antibacterial prescribing decreased from 11% in 2017 to 6% in 2021.
- Chronic pulmonary disease and acute tonsillitis were associated with higher antibiotic prescribing rates.

## Abstract

Antibiotic use is the main driver of antimicrobial resistance and adverse events. The aim of our study was to investigate the magnitude of prescribing antibacterials to outpatients with an acute upper respiratory infection (AURI) in Finland.

For the period 2017–2021, we linked data on antibacterial prescriptions (ATC group J01) from the Finnish Social Insurance Institution with disease data from Primary Care Outpatient Treatment Register and excluded diagnoses for which antibacterial treatment is indicated. We calculated the percentage of visits associated with at least one antibacterial prescription and performed univariate and multivariate logistic regression to assess the effect of year, demographic factors, AURI and selected underlying conditions.

Overall, 9% of all outpatient AURI diagnoses, most of which are of viral origin, were prescribed antibacterials in the public healthcare sector. This proportion decreased from 11% in 2017 to 6% in 2021 and increased with age. Women were slightly more likely to obtain a prescription than men (adjusted probability 1.09; 95%CI 1.08–1.11). Chronic pulmonary disease was associated with increased prescribing for AURIs in the multivariate analysis (adjusted probability 1.93; 95%CI 1.84–2.03), and acute tonsillitis had the highest likelihood of antibacterial prescribing compared with other AURIs (adjusted probability 14.70; 95%CI 13.41–16.12).

Our research indicates that despite previous antimicrobial stewardship efforts, prescribing antibacterials for non-bacterial infections is still common in Finland. Nonetheless, the percentage of inappropriate prescribing decreased over time. Prescribing habits seem to be influenced by patient demographics and underlying chronic illnesses.