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The National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of reducing inappropriate outpatient antibiotic use by 50% by 2020.1 A recent study2 estimated at least 30% of antibiotic prescriptions in ambulatory care settings in the United States from 2010 to 2011 were unnecessary. Inappropriate antibiotic prescribing also includes choosing an unnecessarily broad spectrum antibiotic instead of an equally or more effective narrower spectrum alternative. Otitis media (OM), sinusitis, and pharyngitis collectively account for nearly one-third of all antibiotics prescribed in outpatient settings,2 and professional guidelines recommend narrow spectrum agents as first-line therapy for these conditions.2 Alternatives to first-line therapy are indicated in selected circumstances, including for patients with penicillin allergy or recent treatment failure. Our objective was to measure the frequency with which first-line agents are prescribed for OM, sinusitis, and pharyngitis.


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