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Antibiotic Prescribing for Upper Respiratory Infections

Am Fam Physician. 2004 May 15;69(10):2467.

According to recent research, the rate of antibiotic prescribing has slowed in the United States. Linder and Singer investigated whether patient demand for antibiotics has decreased as a result of the recent slowed rate of prescribing or whether the desire for antibiotics continues to generate the same proportion of prescriptions as noted in earlier research. Patients with respiratory symptoms in a walk-in clinic were surveyed about the perceived severity of their symptoms and their expectations regarding their illness, including desire for antibiotics.

Of the 421 patients who completed surveys, 310 patients met inclusion criteria. When responding to the statement, “I want antibiotics for my illness today,” 51 patients (16 percent) strongly agreed, 69 patients (22 percent) agreed, 145 patients (47 percent) had no opinion, 29 patients (9 percent) disagreed, and 16 patients (5 percent) strongly disagreed. Nineteen percent of patients agreed or strongly agreed with the statement, “Antibiotics work for me when I have a cold.” More than one fourth of patients (29 percent) agreed or strongly agreed with the statement, “I plan on asking the doctor for antibiotics today.” Regarding the statement, “Repeated use of antibiotics can be bad for me in the long run,” 73 percent of patients agreed or strongly agreed. Desire for antibiotics was associated with not having attended college, smoking, and the use of one or more courses of antibiotics per year.

Antibiotics were prescribed to 110 patients (35 percent). Strong predictors of antibiotic prescribing were the desire for antibiotics, fever, abnormal lung examination findings, pharyngeal exudate, tympanic membrane abnormality, sinus tenderness, lymphadenopathy, and sinus pain charted by the physician. Desire for antibiotics remained a significant independent predictor of receiving antibiotics.

In this prospective study, 39 percent of patients wanted antibiotics. The proportion of patients who wanted antibiotics was lower than the proportion in previous studies. It is unknown whether this finding represents on overall decline in desire for antibiotics or was particular to the specific clinic in which the study was conducted. Nonetheless, an association between desire for antibiotics and antibiotic prescribing persists (odds ratio [OR], 2.1), even after adjusting for physical examination findings predictive of antibiotic prescribing. The more antibiotics had been used in the past, the more likely patients were to be given antibiotics again.

Linder JA, Singer DE. Desire for antibiotics and antibiotic prescribing for adults with upper respiratory tract infections. J Gen Intern Med. October 2003;18:795–801.

editor’s note: Other studies have shown that previous positive experiences with antibiotics predict current desire for antibiotic prescriptions. In one study,1 symptomatic adults who wanted antibiotics were more likely than other symptomatic adults to report severe cold symptoms (OR, 2.10; 95 percent confidence interval [CI], 1.22 to 3.67) that had lasted too long (OR, 2.40; 95 percent CI, 1.31 to 4.49), and to have recovered on previous occasions faster with antibiotic therapy (OR, 2.82; 95 percent CI, 1.65 to 4.89). Thus, physicians should avoid reinforcing the perceived benefit of antibiotics by not writing prescriptions for “repeat offenders.” However, this group may be particularly difficult to wean from antibiotics. Educational efforts targeting waiting-room patients appear to be successful.2 Future studies should focus on the impact of such efforts on subgroups of patients with different motivations for wanting antibiotics.—C.W.

 

REFERENCES

1. Braun BL, Fowles JB. Characteristics and experiences of parents and adults who want antibiotics for cold symptoms. Arch Fam Med. 2000;9:589–95.

2. Harris RH, MacKenzie TD, Leeman-Castillo B, Corbett KK, Batal HA, Maselli JH, et al. Optimizing antibiotic prescribing for acute respiratory tract infections in an urgent care clinic. J Gen Intern Med. 2003;18:326–34.


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