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Why Do Physicians Treat Purulent URI with Antibiotics?

Am Fam Physician. 1999 Sep 1;60(3):993-994.

Despite clear principles regarding antibiotic use in patients with upper respiratory infections (URIs), this practice is still widespread. Gonzales and colleagues conducted a prospective cohort study to determine which clinical characteristics in patients cause physicians to prescribe antibiotics for non-antibiotic responsive conditions (i.e., URIs).

Patients enrolled in a group-model health maintenance organization were included in the study if they had symptoms involving the chest, throat, ears or nasal passage. Each visit was documented in a standardized fashion, and adult patients with a final diagnosis of URI were included for analysis. Patients with diagnoses of pneumonia, acute bronchitis, otitis media, sinusitis or pharyngitis were excluded. (Even though acute bronchitis is not an indication for antibiotics, many physicians continue to prescribe antibiotics for this condition.)

The clinical manifestations most often reported by the 451 patients diagnosed with URI were cough, sore throat, rhinorrhea, headache, fatigue and postnasal drip. One half of patients had pharyngeal erythema; about one quarter had cervical lymphadenopathy and sinus tenderness. Thirty percent of patients had no abnormal physical findings. Antibiotics were given to one third of patients; the clinical characteristics associated with antibiotic prescriptions were green phlegm, green or yellow nasal discharge, purulent nasal discharge, tonsillar exudate and tobacco use. The authors emphasize previous research that has found that these characteristics are not associated with a better outcome when treated with antibiotics.

The authors conclude that despite much research showing no benefit to antibiotic treatment in patients with URIs, physicians continue to prescribe antibiotics in these situations. Studies in the past have focused on patient expectation as the reason physicians continue to prescribe antibiotics; however, clinical presentation may be a factor as well. The authors recommend greater efforts to educate physicians about the appropriate treatment of purulent manifestations of URIs.

Gonzales R, et al. The relation between purulent manifestations and antibiotic treatment of upper respiratory tract infections. J Gen Intern Med. March 1999;14:151–6.


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