Antibiotic Overprescription for Upper Respiratory Infections
Antibiotic Overprescription for Upper Respiratory Infections
Background: The dangers of overuse of antibiotics for upper respiratory infections (URIs) has been widely recognized, but the rate of change in prescribing patterns in recent years is unknown.
Methods: Data on the use of antibiotics for URIs was extracted from the 1997 to 1999 National Ambulatory Medical Care Survey (a national multistage probability sample survey of patients' office visits to office-based physicians). Adult patients (≥18 years) with a primary diagnosis of URI (bronchitis, common colds, and other acute upper respiratory infections) were included. The decision to prescribe antibiotics was modeled as a function of patient, physician, and practice characteristics using logistic regression.
Results: The rate of antibiotic prescription for URIs decreased from 52.1% in 1997 to 41.5% in 1999. In a multivariate logistic regression model, treatment by general internal medicine physicians [odds ratio (OR), 0.37; 95% confidence interval (CI), 0.18 to 0.76] was associated with lower prescription rates. Of patients visiting general internal medicine physicians for URIs, 36.2% received antibiotics compared with 42.9% of those seeing a general/family medicine physician. Patients treated by their primary care physicians had a higher risk of receiving antibiotics (OR, 1.70; 95% CI, 1.08 to 2.68).
Conclusions: Despite a downward trend in antibiotic prescribing over the years, overprescription of antibiotics for upper respiratory infections persists. General internal medicine physicians are less likely than general/family physicians to prescribe antibiotics, but this gap seems to be narrowing. Specific interventions must be designed to address these disparities.
Overuse of antibiotics in adult ambulatory practice is one of the contributing factors to the increase of antibiotic-resistant bacteria in the community. In particular, penicillin resistance in Streptococcus pneumoniae has increased dramatically during the last 10 years and previous antibiotic use has been identified as a major risk factor for carriage and spread of antibiotic-resistant S pneumoniae.
Although an overwhelming majority of upper respiratory tract infections are of viral origin, more than 50% of patients diagnosed with colds, upper respiratory tract infections, or bronchitis were prescribed antibiotics in an analysis of the 1992 National Ambulatory Medical Care Survey (NAMCS). Despite an increasing awareness of the problem, there is little evidence that practice has changed in recent years.
The objective of this study is to explore whether antibiotic prescription practices for upper respiratory tract infections have changed and to determine the influence of physician and practice characteristics on antibiotic prescribing.
Background: The dangers of overuse of antibiotics for upper respiratory infections (URIs) has been widely recognized, but the rate of change in prescribing patterns in recent years is unknown.
Methods: Data on the use of antibiotics for URIs was extracted from the 1997 to 1999 National Ambulatory Medical Care Survey (a national multistage probability sample survey of patients' office visits to office-based physicians). Adult patients (≥18 years) with a primary diagnosis of URI (bronchitis, common colds, and other acute upper respiratory infections) were included. The decision to prescribe antibiotics was modeled as a function of patient, physician, and practice characteristics using logistic regression.
Results: The rate of antibiotic prescription for URIs decreased from 52.1% in 1997 to 41.5% in 1999. In a multivariate logistic regression model, treatment by general internal medicine physicians [odds ratio (OR), 0.37; 95% confidence interval (CI), 0.18 to 0.76] was associated with lower prescription rates. Of patients visiting general internal medicine physicians for URIs, 36.2% received antibiotics compared with 42.9% of those seeing a general/family medicine physician. Patients treated by their primary care physicians had a higher risk of receiving antibiotics (OR, 1.70; 95% CI, 1.08 to 2.68).
Conclusions: Despite a downward trend in antibiotic prescribing over the years, overprescription of antibiotics for upper respiratory infections persists. General internal medicine physicians are less likely than general/family physicians to prescribe antibiotics, but this gap seems to be narrowing. Specific interventions must be designed to address these disparities.
Overuse of antibiotics in adult ambulatory practice is one of the contributing factors to the increase of antibiotic-resistant bacteria in the community. In particular, penicillin resistance in Streptococcus pneumoniae has increased dramatically during the last 10 years and previous antibiotic use has been identified as a major risk factor for carriage and spread of antibiotic-resistant S pneumoniae.
Although an overwhelming majority of upper respiratory tract infections are of viral origin, more than 50% of patients diagnosed with colds, upper respiratory tract infections, or bronchitis were prescribed antibiotics in an analysis of the 1992 National Ambulatory Medical Care Survey (NAMCS). Despite an increasing awareness of the problem, there is little evidence that practice has changed in recent years.
The objective of this study is to explore whether antibiotic prescription practices for upper respiratory tract infections have changed and to determine the influence of physician and practice characteristics on antibiotic prescribing.