# INTRODUCTION

Acute respiratory infections (ARIs) are common in outpatient settings and account for 41% of all antibiotics prescribed in ambulatory settings, about half of which are medically unnecessary.1,2 Common ARIs treated in outpatient settings include sinusitis, otitis media, bronchitis, and pharyngitis. Many of these infections are caused by viruses but are inappropriately treated with antibiotics.1,3 This misuse of antibiotics has serious consequences, including the emergence of antibiotic resistant infections and drug-related adverse events. According to the Centers for Disease Control, 2.8 million antibiotic resistant infections occur annually in the United States, 35 000 of which are fatal.4 An additional 12 800 fatalities are caused by antibiotic-associated Clostridium difficile infections.4 Antibiotic-related adverse events are a common cause of both hospitalizations and emergency department (ED) visits, accounting for over 16% of all outpatient adverse drug event visits.5