Publication date: Jul 31, 2026
Antibiotic overuse for acute respiratory tract infections (ARTIs) remains common in emergency departments (EDs), but national trends among older adults are not well described. We conducted a retrospective cohort study of US ED encounters in Epic Cosmos (January 2013-December 2025) among adults aged 65 years or older with never-appropriate ARTI diagnoses. Monthly antibiotic overuse (ED administration and/or discharge prescription) was evaluated with segmented regression around Centers for Disease Control and Prevention (CDC) Core Elements (November 2016), The Joint Commission (TJC) ambulatory stewardship standard (January 2020), COVID-19 onset (March 2020), and Centers for Medicare & Medicaid Services (CMS) interpretive guidance (July 2022). Among 838,929 encounters, antibiotic overuse occurred in 38. 5%. In the primary model, estimated 12-month changes were -5. 0 percentage points (95% CI, -7. 1 to -3. 0; P
| Concepts | Keywords |
|---|---|
| antibiotic stewardship | |
| antimicrobial resistance | |
| emergency department | |
| interrupted time series | |
| older adults |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | Respiratory Tract Infections |
| disease | MESH | Emergency |
| disease | MESH | COVID-19 |