Over the past years, ED physicians have become accustomed to the core measures of pneumonia treatment implemented by the Joint Commission and the Centers for Medicare & Medicaid Services (http://www.jointcommission.org/pneumomia). Because of the heightened awareness of the burden of missed diagnosis of pneumonia, it is possible that ED physicians may have extended the use of imaging appropriate for a population at higher risks, i.e., the elderly population, to a Mdm2 inhibitor molecular weight younger and healthier age group. There are several limitations in the current

study. First, readers need to exercise cautions in comparing the prevalence rates obtained from the current study with those from prior studies due to different inclusion/exclusion Inhibitors,research,lifescience,medical criteria. The current study aimed to examine providers’ compliance with CDC guidelines. Consequently, the simplest form of URIs without any comorbidities in the healthiest population (18–64years Inhibitors,research,lifescience,medical of age) were selected to eliminate justifiable deviations from the guidelines. As the result, the current study may have underestimated the prevalence of antibiotic and imaging prescriptions in the overall population and the results cannot be generalized to the pediatric and elderly populations. This also highlights the need

of expanding the guidelines to encompass prevalent Inhibitors,research,lifescience,medical comorbidities, particularly those affecting respiratory, cardiovascular and immune systems. As the prevalence of chronic conditions grows in Inhibitors,research,lifescience,medical the US population, more research and concerted

efforts are warranted to refine the existing URI treatment guidelines to curtail the over-prescribing of antibiotics and imaging studies in the EDs. Second, physical findings were not present in the data; ordering of some of the tests may have been appropriate if certain physical findings, for example, crackles heard upon auscultation, were taken into consideration. Third, any limitations or inconsistences in the ICD-9 coding of patient visits would lead to Inhibitors,research,lifescience,medical biases that are inherent in all studies involving coding. Despite the recommendations and campaign efforts by the CDC and many medical associations, the prescribing enough of antibiotics in treating uncomplicated URIs in the EDs remains prevalent. Furthermore, overutilization of imaging studies is prevalent. Changes at levels of health care system and hospitals are needed to avoid unnecessary resource utilization. In addition, further patient education about antibiotic use in the community may greatly facilitate the transition out of an antibiotic-dependent consumer culture. Conclusion Despite the recommendations and campaign efforts by the CDC and many medical associations, the prescribing of antibiotics in treating uncomplicated URIs in the EDs remains prevalent. Overutilization of imaging studies is also prevalent. Changes at levels of health care system and hospitals are needed to avoid unnecessary resource utilization.